Provider Demographics
NPI:1346306909
Name:STACHOLY, MARIELA (MD)
Entity type:Individual
Prefix:
First Name:MARIELA
Middle Name:
Last Name:STACHOLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COND PLAYA DORADA
Mailing Address - Street 2:APT. 516A
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-7009
Mailing Address - Country:US
Mailing Address - Phone:939-644-1122
Mailing Address - Fax:
Practice Address - Street 1:COND PLAYA DORADA
Practice Address - Street 2:APT. 516A
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979-7009
Practice Address - Country:US
Practice Address - Phone:939-644-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13523208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR13523Medicare UPIN