1417989591 NPI number — DR. GLORIA E. GARCIA-MARISCAL M.D.

Table of content: DR. GLORIA E. GARCIA-MARISCAL M.D. (NPI 1417989591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417989591 NPI number — DR. GLORIA E. GARCIA-MARISCAL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARCIA-MARISCAL
Provider First Name:
GLORIA
Provider Middle Name:
E.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417989591
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1535 E 10TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOUGLAS
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85607-2309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-805-0650
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1535 E 10TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOUGLAS
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85607-2309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-805-0650
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  25592 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01-01097 . This is a "UNITEDHEALTHCARE OF ARIZO" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: B1013244 . This is a "ADMINISTRATIVE ENTERPRISE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 25592 . This is a "MEDICAL LICENCE NUMBER" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 3343816 . This is a "CIGNA HEALTHCARE OF AZ IN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 86-0906731 . This is a "TAX ID. NO." identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0824870 . This is a "BC/BS OF AZ" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 2856780 . This is a "CMDP NUMMBER" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 000171608 . This is a "MEDICARECOMPLETE PROVIDER" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 285678-004 . This is a "ARIZONA PHYSICIANS IPA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ9999 . This is a "MUTUAL OF OMAHA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 003468 . This is a "RURAL ARIZONA NETWORK" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 285678 . This is a "MERCY CARE PLAN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 285678 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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