Provider Demographics
NPI:1265833024
Name:MARIN GARCIA, GERALD LEE
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:LEE
Last Name:MARIN GARCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4289 AVE CONSTANCIA
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-2120
Mailing Address - Country:US
Mailing Address - Phone:787-365-9355
Mailing Address - Fax:
Practice Address - Street 1:4289 AVE CONSTANCIA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-2120
Practice Address - Country:US
Practice Address - Phone:787-365-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19894207P00000X, 207RC0200X
PR32405390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program