Basic Information
| Provider Information | |||||||||
| NPI: | 1720503162 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OLIVA-GARCIA | ||||||||
| FirstName: | ISBELL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17063 SW 215TH TER | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331874313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3053036631 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8785 SW 165TH AVE STE 103 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33193 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7862066500 | ||||||||
| FaxNumber: | 7862064702 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2017 | ||||||||
| LastUpdateDate: | 08/22/2018 | ||||||||
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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 | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst | 101YM0800X | MH15187 | FL | N | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.