Provider Demographics
NPI:1629642780
Name:GARCED DEL VALLE, MARIELIE
Entity Type:Individual
Prefix:
First Name:MARIELIE
Middle Name:
Last Name:GARCED DEL VALLE
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:PO BOX 649
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-0649
Mailing Address - Country:US
Mailing Address - Phone:787-469-6046
Mailing Address - Fax:
Practice Address - Street 1:BO. CEIBA SECTOR JUAN NIEVES
Practice Address - Street 2:CARR 173 R 782 KM 4.9
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739
Practice Address - Country:US
Practice Address - Phone:787-469-6046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program