Provider Demographics
NPI:1467323113
Name:OLIVARES GARCIA, LIZ JOHANNA
Entity type:Individual
Prefix:
First Name:LIZ
Middle Name:JOHANNA
Last Name:OLIVARES GARCIA
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 1:1031 W 27TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-1186
Mailing Address - Country:US
Mailing Address - Phone:786-893-9105
Mailing Address - Fax:
Practice Address - Street 1:1031 W 27TH ST APT 1
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-1186
Practice Address - Country:US
Practice Address - Phone:786-893-9105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-468272106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician