Provider Demographics
NPI:1396416756
Name:GINES ROSARIO, MARIELA (MEDICAL STUDENT)
Entity Type:Individual
Prefix:
First Name:MARIELA
Middle Name:
Last Name:GINES ROSARIO
Suffix:
Gender:F
Credentials:MEDICAL STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 PRADERAS DEL PLATA
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-3160
Mailing Address - Country:US
Mailing Address - Phone:787-329-0411
Mailing Address - Fax:
Practice Address - Street 1:27 PRADERAS DEL PLATA
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-3160
Practice Address - Country:US
Practice Address - Phone:787-329-0411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-25
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6015299OtherDRIVER'S LICENSE