Provider Demographics
NPI:1609516905
Name:GARCIA EXPOSITO, ISMARAY RISELDA
Entity Type:Individual
Prefix:
First Name:ISMARAY
Middle Name:RISELDA
Last Name:GARCIA EXPOSITO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4311 SW 112TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-4743
Mailing Address - Country:US
Mailing Address - Phone:305-397-5693
Mailing Address - Fax:
Practice Address - Street 1:4311 SW 112TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-4743
Practice Address - Country:US
Practice Address - Phone:305-397-5693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-133842106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician