Provider Demographics
NPI:1790058253
Name:MARA ELENA DE GARCIA MD PA
Entity Type:Organization
Organization Name:MARA ELENA DE GARCIA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARA
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:DE GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-531-4186
Mailing Address - Street 1:1562 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-7801
Mailing Address - Country:US
Mailing Address - Phone:305-531-4186
Mailing Address - Fax:305-674-0159
Practice Address - Street 1:1562 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-7801
Practice Address - Country:US
Practice Address - Phone:305-531-4186
Practice Address - Fax:305-674-0159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 34210207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGA323AMedicare PIN