Provider Demographics
NPI:1770679854
Name:GARCIA, MARIELA
Entity Type:Individual
Prefix:DR
First Name:MARIELA
Middle Name:
Last Name:GARCIA
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:PROFESSIONAL HOSPITAL
Mailing Address - Street 2:CARR 199 AVE LAS CUMBRES
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PROFESSIONAL HOSPITAL CARR. #2 KM. 49.5
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-884-0505
Practice Address - Fax:787-884-0510
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15263281P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI43968Medicare UPIN