Healthcare Provider Details

I. General information

NPI: 1013984004
Provider Name (Legal Business Name): MARI TERE GARCIA-RONDON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 09/23/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TORRE DEL METROPOLITANO SUITE 408
SAN JUAN PR
00926
US

IV. Provider business mailing address

PO BOX 40760
MESA AZ
85274
US

V. Phone/Fax

Practice location:
  • Phone: 787-455-9535
  • Fax: 787-455-9389
Mailing address:
  • Phone: 480-706-9430
  • Fax: 480-461-1785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number12865
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number12865
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number12865
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: