Provider Demographics
NPI:1659064509
Name:GARCIA LA ROSA, DAYLEN
Entity Type:Individual
Prefix:
First Name:DAYLEN
Middle Name:
Last Name:GARCIA LA ROSA
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 1:918 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33405-3002
Mailing Address - Country:US
Mailing Address - Phone:561-236-5887
Mailing Address - Fax:561-486-3072
Practice Address - Street 1:2500 QUANTUM LAKES DR STE 203
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8323
Practice Address - Country:US
Practice Address - Phone:561-409-8240
Practice Address - Fax:561-486-3072
Is Sole Proprietor?:No
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-272337106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician