Provider Demographics
NPI:1134975147
Name:GIL GARCIA, SULEYVIS
Entity type:Individual
Prefix:
First Name:SULEYVIS
Middle Name:
Last Name:GIL 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 1:1390 ARROWHEAD POINT RD
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-6167
Mailing Address - Country:US
Mailing Address - Phone:561-939-9997
Mailing Address - Fax:
Practice Address - Street 1:1390 ARROWHEAD POINT RD
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-6167
Practice Address - Country:US
Practice Address - Phone:561-939-9997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-29
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-343809106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician