Provider Demographics
NPI:1891423950
Name:GARCIA MARTINEZ, SERGIA
Entity Type:Individual
Prefix:
First Name:SERGIA
Middle Name:
Last Name:GARCIA MARTINEZ
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 1:8875 NW 109TH TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4547
Mailing Address - Country:US
Mailing Address - Phone:305-345-7971
Mailing Address - Fax:
Practice Address - Street 1:8875 NW 109TH TER
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-4547
Practice Address - Country:US
Practice Address - Phone:305-345-7971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112459900Medicaid