Provider Demographics
NPI:1154187789
Name:MIRABAL GARCIA, MARCOS MICHEL
Entity type:Individual
Prefix:
First Name:MARCOS
Middle Name:MICHEL
Last Name:MIRABAL GARCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7602 BIPE LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-3408
Mailing Address - Country:US
Mailing Address - Phone:833-611-0055
Mailing Address - Fax:
Practice Address - Street 1:7602 BIPE LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-3408
Practice Address - Country:US
Practice Address - Phone:833-611-0055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLM614553820660172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver