Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health |
NPI | 1821445297 |
---|---|
Provider Name | Chavely Garcia |
First Address | Orlando, FL 32819-9096 |
Second Address | Orlando, FL 32819-9096 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2016 |
Last Update Date | 16/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
N/A | N/A (01) |