Provider Demographics
NPI:1497544910
Name:PLA DE MARI, JAIME MIKEL
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:MIKEL
Last Name:PLA DE MARI
Suffix:
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:CALLE HIGUERO, LADERAS DE SAN JUAN
Mailing Address - Street 2:#34
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-612-4151
Mailing Address - Fax:
Practice Address - Street 1:4200 5TH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:PA
Practice Address - Zip Code:15213-3583
Practice Address - Country:US
Practice Address - Phone:787-612-4151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA146N00000X, 2255A2300X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer