Provider Demographics
NPI:1710501614
Name:GARABOA, JISELL
Entity Type:Individual
Prefix:
First Name:JISELL
Middle Name:
Last Name:GARABOA
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 1:3220 NW 211TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-1004
Mailing Address - Country:US
Mailing Address - Phone:786-542-3264
Mailing Address - Fax:
Practice Address - Street 1:10689 N KENDALL DR STE 309
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1525
Practice Address - Country:US
Practice Address - Phone:786-536-7470
Practice Address - Fax:786-536-7951
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician