Provider Demographics
NPI:1790929883
Name:GARCIA, ENITH LILIANA
Entity Type:Individual
Prefix:
First Name:ENITH
Middle Name:LILIANA
Last Name:GARCIA
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 1:8961 DANIELS CENTER DRIVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-0314
Mailing Address - Country:US
Mailing Address - Phone:239-433-6700
Mailing Address - Fax:239-433-6703
Practice Address - Street 1:8961 DANIELS CENTER DRIVE
Practice Address - Street 2:SUITE 401
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-0314
Practice Address - Country:US
Practice Address - Phone:239-433-6700
Practice Address - Fax:239-433-6703
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X, 104100000X
FLSZ9308235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104214600Medicaid
FL000806100Medicaid