Provider Demographics
NPI:1851898175
Name:GARCIA RODRIGUEZ, EMILE MARGOT
Entity Type:Individual
Prefix:
First Name:EMILE
Middle Name:MARGOT
Last Name:GARCIA RODRIGUEZ
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 1:2909 FRENCH AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-3716
Mailing Address - Country:US
Mailing Address - Phone:561-373-7478
Mailing Address - Fax:
Practice Address - Street 1:2909 FRENCH AVE
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-3716
Practice Address - Country:US
Practice Address - Phone:561-373-7478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-12
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-1859716106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty