Provider Demographics
NPI:1659781201
Name:GARCIA, MARTHA O X
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:O
Last Name:GARCIA
Suffix:X
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 1:9813 SW 221ST ST
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1404
Mailing Address - Country:US
Mailing Address - Phone:786-348-4813
Mailing Address - Fax:
Practice Address - Street 1:11320 SW 245TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032
Practice Address - Country:US
Practice Address - Phone:786-556-2478
Practice Address - Fax:305-675-8056
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA14227235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSZ6622OtherLICENSE SPEECH LANGUAGE PATHOLOGY