Healthcare Provider Details

I. General information

NPI: 1497544910
Provider Name (Legal Business Name): JAIME MIKEL PLA DE MARI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 05/01/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 5TH AVE
OAKLAND PA
15213-3583
US

IV. Provider business mailing address

CALLE HIGUERO, LADERAS DE SAN JUAN #34
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-612-4151
  • Fax:
Mailing address:
  • Phone: 787-612-4151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: