Healthcare Provider Details

I. General information

NPI: 1629642780
Provider Name (Legal Business Name): MARIELIE GARCED DEL VALLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 05/13/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO. CEIBA SECTOR JUAN NIEVES CARR 173 R 782 KM 4.9
CIDRA PR
00739
US

IV. Provider business mailing address

PO BOX 649
CIDRA PR
00739-0649
US

V. Phone/Fax

Practice location:
  • Phone: 787-469-6046
  • Fax:
Mailing address:
  • Phone: 787-469-6046
  • 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 State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: