Provider Demographics
NPI:1336808443
Name:GARCIA RODRIGUEZ, MABEL YUNELYS
Entity Type:Individual
Prefix:
First Name:MABEL
Middle Name:YUNELYS
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 1:22051 SW 126TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33170-2740
Mailing Address - Country:US
Mailing Address - Phone:786-431-6724
Mailing Address - Fax:
Practice Address - Street 1:22051 SW 126TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33170-2740
Practice Address - Country:US
Practice Address - Phone:786-431-6724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20-127259106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician