Provider Demographics
NPI:1235546086
Name:GARCIA-GONZALEZ, MYRIAM ISAURA (MD)
Entity Type:Individual
Prefix:
First Name:MYRIAM
Middle Name:ISAURA
Last Name:GARCIA-GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:URB PARAISO DE MAYAGUEZ
Mailing Address - Street 2:197 SERENIDAD STREET
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-616-5534
Mailing Address - Fax:
Practice Address - Street 1:NEWPORT IV- SUITE 202
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920
Practice Address - Country:US
Practice Address - Phone:787-705-8832
Practice Address - Fax:833-798-4885
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-14
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19529207R00000X
PR19,529390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine