Provider Demographics
NPI:1578143400
Name:GARCIA AVILA, MARTHA M (RBT)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:M
Last Name:GARCIA AVILA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3354 SW 25TH TER APT R
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-2022
Mailing Address - Country:US
Mailing Address - Phone:786-780-8458
Mailing Address - Fax:
Practice Address - Street 1:3354 SW 25TH TER APT R
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-2022
Practice Address - Country:US
Practice Address - Phone:786-780-8458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-156315106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician