Provider Demographics
NPI:1053991166
Name:GARCIA AVILA, MARIA DEL SAGRARIO
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:DEL SAGRARIO
Last Name:GARCIA AVILA
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 1:4500 W 19TH CT APT D331
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2838
Mailing Address - Country:US
Mailing Address - Phone:786-536-0055
Mailing Address - Fax:
Practice Address - Street 1:4500 W 19TH CT APT D331
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2838
Practice Address - Country:US
Practice Address - Phone:786-536-0055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-124859106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician