Provider Demographics
NPI:1437908811
Name:GARCIA, NIKOLAS MYKAL
Entity type:Individual
Prefix:
First Name:NIKOLAS
Middle Name:MYKAL
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 1:1128 NW 7TH AVE UNIT 1008
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-2379
Mailing Address - Country:US
Mailing Address - Phone:786-253-7241
Mailing Address - Fax:
Practice Address - Street 1:7601 N FEDERAL HWY STE 150A
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-1663
Practice Address - Country:US
Practice Address - Phone:754-399-8507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-341424106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician