Provider Demographics
NPI:1740885664
Name:MULET GARCIA, MARIELA
Entity type:Individual
Prefix:
First Name:MARIELA
Middle Name:
Last Name:MULET 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 1:2560 KEYSTONE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-2941
Mailing Address - Country:US
Mailing Address - Phone:786-318-9523
Mailing Address - Fax:
Practice Address - Street 1:13401 SUMMERLIN RD STE 8
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-6593
Practice Address - Country:US
Practice Address - Phone:239-415-1880
Practice Address - Fax:239-415-1884
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH22317124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist