Provider Demographics
NPI:1639792104
Name:GARCIA PUPO, MADELEINY (CBHCM)
Entity Type:Individual
Prefix:
First Name:MADELEINY
Middle Name:
Last Name:GARCIA PUPO
Suffix:
Gender:F
Credentials:CBHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 NW 183RD ST STE 240B
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33169-4551
Mailing Address - Country:US
Mailing Address - Phone:786-712-1712
Mailing Address - Fax:
Practice Address - Street 1:99 NW 183RD ST STE 240B
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33169-4551
Practice Address - Country:US
Practice Address - Phone:786-712-1712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty