Provider Demographics
NPI:1255832044
Name:GARCIA-MULERO, GRACENEL
Entity Type:Individual
Prefix:
First Name:GRACENEL
Middle Name:
Last Name:GARCIA-MULERO
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 1:2600 SW 10TH ST APT 208
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-8822
Mailing Address - Country:US
Mailing Address - Phone:386-457-9773
Mailing Address - Fax:
Practice Address - Street 1:2600 SW 10TH ST APT 208
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-8822
Practice Address - Country:US
Practice Address - Phone:386-457-9773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSMedicaid