Provider Demographics
NPI:1417768755
Name:GARCIA PEREZ, ODALIS (MHTC)
Entity type:Individual
Prefix:
First Name:ODALIS
Middle Name:
Last Name:GARCIA PEREZ
Suffix:
Gender:F
Credentials:MHTC
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MHTC
Mailing Address - Street 1:3700 SW 82ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3430
Mailing Address - Country:US
Mailing Address - Phone:786-814-7810
Mailing Address - Fax:
Practice Address - Street 1:3700 SW 82ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3430
Practice Address - Country:US
Practice Address - Phone:786-814-7810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician