Basic Information
| Provider Information | |||||||||
| NPI: | 1003028804 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARCIA | ||||||||
| FirstName: | GERTRUDIS | ||||||||
| MiddleName: | CLARA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15353 SW 39TH TER | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331854703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052253423 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9380 SW 72ND ST STE B120 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331735456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052743172 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | IMT 658 | FL | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.