Provider Demographics
NPI:1235712084
Name:BURGALIN, MARIELA A
Entity Type:Individual
Prefix:
First Name:MARIELA
Middle Name:A
Last Name:BURGALIN
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 1:12890 OLD MERIDIAN ST APT 454
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-8950
Mailing Address - Country:US
Mailing Address - Phone:786-399-0735
Mailing Address - Fax:
Practice Address - Street 1:603 SW 57TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-3919
Practice Address - Country:US
Practice Address - Phone:305-774-1788
Practice Address - Fax:305-774-1789
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN46004412A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist