Healthcare Provider Details

I. General information

NPI: 1780040956
Provider Name (Legal Business Name): MARIA ISAAC GARCIA TO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URBANIZACION VILLAS DEL SOL CALLE 2 F-9
TRUJILLO ALTO PUERTO RICO
00976
UM

IV. Provider business mailing address

URBANIZACION VILLAS DEL SOL CALLE 2 F-9
TRUJILLO ALTO PUERTO RICO
00976
UM

V. Phone/Fax

Practice location:
  • Phone: 787-410-4651
  • Fax:
Mailing address:
  • Phone: 787-410-4651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number592
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: