Healthcare Provider Details

I. General information

NPI: 1346306909
Provider Name (Legal Business Name): MARIELA STACHOLY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 CALLE CORONEL
ISABELA PR
00662-4800
US

IV. Provider business mailing address

24 CALLE CORONEL
ISABELA PR
00662-4800
US

V. Phone/Fax

Practice location:
  • Phone: 939-644-1122
  • Fax:
Mailing address:
  • Phone: 939-644-1122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13523
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1720455876
Identifier TypeMEDICAID
Identifier StatePR
Identifier Issuer
# 2
Identifier1972952760
Identifier TypeMEDICAID
Identifier StatePR
Identifier Issuer
# 3
Identifier1083828479
Identifier TypeMEDICAID
Identifier StatePR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: