Provider Demographics
NPI:1417989591
Name:GARCIA-MARISCAL, GLORIA E (MD)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:E
Last Name:GARCIA-MARISCAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:AZ
Mailing Address - Zip Code:85607-2309
Mailing Address - Country:US
Mailing Address - Phone:520-805-0650
Mailing Address - Fax:
Practice Address - Street 1:1535 E 10TH ST
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:AZ
Practice Address - Zip Code:85607-2309
Practice Address - Country:US
Practice Address - Phone:520-805-0650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25592207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ01-01097OtherUNITEDHEALTHCARE OF ARIZO
AZB1013244OtherADMINISTRATIVE ENTERPRISE
AZ25592OtherMEDICAL LICENCE NUMBER
AZ3343816OtherCIGNA HEALTHCARE OF AZ IN
AZ86-0906731OtherTAX ID. NO.
AZAZ0824870OtherBC/BS OF AZ
AZ2856780OtherCMDP NUMMBER
AZ000171608OtherMEDICARECOMPLETE PROVIDER
AZ285678-004OtherARIZONA PHYSICIANS IPA
AZAZ9999OtherMUTUAL OF OMAHA
AZ003468OtherRURAL ARIZONA NETWORK
AZ285678OtherMERCY CARE PLAN
AZ285678Medicaid
AZ285678Medicaid