Provider Demographics
NPI:1669036315
Name:SAN BLAS GARCIA, JESSABELL (RBT)
Entity Type:Individual
Prefix:
First Name:JESSABELL
Middle Name:
Last Name:SAN BLAS GARCIA
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 1:11821 SW 170TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-2156
Mailing Address - Country:US
Mailing Address - Phone:786-646-7813
Mailing Address - Fax:
Practice Address - Street 1:11821 SW 170TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-2156
Practice Address - Country:US
Practice Address - Phone:786-646-7813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-29
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106E00000X
FLRBT-19-84801106S00000X
0-21-11901106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician