Provider Demographics
NPI:1710188982
Name:GARCIA, MANOLO (PSYD)
Entity Type:Individual
Prefix:MR
First Name:MANOLO
Middle Name:
Last Name:GARCIA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10305 NW 41ST ST
Mailing Address - Street 2:205
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2396
Mailing Address - Country:US
Mailing Address - Phone:305-718-9800
Mailing Address - Fax:305-718-9080
Practice Address - Street 1:10305 NW 41ST ST
Practice Address - Street 2:205
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2396
Practice Address - Country:US
Practice Address - Phone:305-718-9800
Practice Address - Fax:305-718-9080
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6613103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical