Provider Demographics
NPI:1629952353
Name:GARCIA MONDRAGON, BERLYTZ EDISA
Entity type:Individual
Prefix:
First Name:BERLYTZ
Middle Name:EDISA
Last Name:GARCIA MONDRAGON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 SW 42ND AVE APT 20
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1965
Mailing Address - Country:US
Mailing Address - Phone:786-461-4878
Mailing Address - Fax:
Practice Address - Street 1:530 SW 42ND AVE APT 20
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1965
Practice Address - Country:US
Practice Address - Phone:786-461-4878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician