Provider Demographics
NPI:1891271797
Name:JATIVA GARCIA, ANDREINA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREINA
Middle Name:
Last Name:JATIVA GARCIA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 NE 96TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2553
Mailing Address - Country:US
Mailing Address - Phone:786-597-7712
Mailing Address - Fax:
Practice Address - Street 1:1130 E HALLANDALE BEACH BLVD
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009
Practice Address - Country:US
Practice Address - Phone:305-912-4039
Practice Address - Fax:305-909-9686
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN235431223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice