Provider Demographics
NPI:1659918464
Name:GRATEROL DE ARREAZA, MARISOL DEL VALLE (SA-C)
Entity Type:Individual
Prefix:
First Name:MARISOL
Middle Name:DEL VALLE
Last Name:GRATEROL DE ARREAZA
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8980 W FLAGLER ST APT 213
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-3973
Mailing Address - Country:US
Mailing Address - Phone:786-247-1275
Mailing Address - Fax:
Practice Address - Street 1:8980 W FLAGLER ST APT 213
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-3973
Practice Address - Country:US
Practice Address - Phone:786-247-1275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-01
Last Update Date:2019-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19-497246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty