Provider Demographics
NPI:1477309474
Name:GARCIA LIZAMA, DAYAMIS
Entity type:Individual
Prefix:
First Name:DAYAMIS
Middle Name:
Last Name:GARCIA LIZAMA
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 1:8305 SW 72ND AVE APT 308A
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-7668
Mailing Address - Country:US
Mailing Address - Phone:786-326-0081
Mailing Address - Fax:
Practice Address - Street 1:8305 SW 72ND AVE APT 308A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-7668
Practice Address - Country:US
Practice Address - Phone:786-326-0081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-338843106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty