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Individual

ILEANA GARCIA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
2900 SW 20TH ST, MIAMI, FL 33145-2340
(786) 286-3406
Mailing address
2900 SW 20 STREET, MIAMI, FL 33145-2340

Taxonomy

Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
58925
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
692086179
FL
Enumeration date
05/21/2012
Last updated
05/21/2012
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