Provider Demographics
NPI:1255149621
Name:RICANO GARCIA, ALEXIS
Entity type:Individual
Prefix:PROF
First Name:ALEXIS
Middle Name:
Last Name:RICANO GARCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 SW 98TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2940
Mailing Address - Country:US
Mailing Address - Phone:305-877-9408
Mailing Address - Fax:
Practice Address - Street 1:2800 SW 98TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2940
Practice Address - Country:US
Practice Address - Phone:305-877-9408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician