Provider Demographics
NPI:1952189524
Name:GARCIA, NATHAN RUBEN
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:RUBEN
Last Name: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 1:4402 SE CHESAPEAKE BAY DR
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-5547
Mailing Address - Country:US
Mailing Address - Phone:772-708-9726
Mailing Address - Fax:
Practice Address - Street 1:4402 SE CHESAPEAKE BAY DR
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-5547
Practice Address - Country:US
Practice Address - Phone:772-708-9726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-23-297018106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician