Provider Demographics
NPI:1699221515
Name:MARIANI OSTOLAZA, JOSE MARCOS I
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:MARCOS
Last Name:MARIANI OSTOLAZA
Suffix:I
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:C14 BDA LA OLIMPIA
Mailing Address - Street 2:
Mailing Address - City:ADJUNTAS
Mailing Address - State:PR
Mailing Address - Zip Code:00601-2368
Mailing Address - Country:US
Mailing Address - Phone:787-214-7445
Mailing Address - Fax:
Practice Address - Street 1:CASTANER GENERAL HOSPITAL
Practice Address - Street 2:CARR 135 KM 64.2
Practice Address - City:CASTANER
Practice Address - State:PR
Practice Address - Zip Code:00601
Practice Address - Country:US
Practice Address - Phone:787-829-5010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14178-I208D00000X
PR19792208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty