Provider Demographics
NPI:1821518119
Name:GARCIA, MARIA DUFAY SR
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:DUFAY
Last Name:GARCIA
Suffix:SR
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 1:7501 E TREASURE DR APT 1P
Mailing Address - Street 2:
Mailing Address - City:NORTH BAY VILLAGE
Mailing Address - State:FL
Mailing Address - Zip Code:33141-4301
Mailing Address - Country:US
Mailing Address - Phone:786-508-4597
Mailing Address - Fax:
Practice Address - Street 1:7501 E TREASURE DR, APT 1P
Practice Address - Street 2:
Practice Address - City:NORTH BAY VILLAGE
Practice Address - State:FL
Practice Address - Zip Code:33141-4103
Practice Address - Country:US
Practice Address - Phone:786-508-4597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL$$$$$$$$$OtherSOCIAL SECURITY