Provider Demographics
NPI:1366282238
Name:OCASIO, MARA
Entity type:Individual
Prefix:
First Name:MARA
Middle Name:
Last Name:OCASIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 CALLE VENUS
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-9213
Mailing Address - Country:US
Mailing Address - Phone:787-942-8192
Mailing Address - Fax:
Practice Address - Street 1:43 CALLE VENUS
Practice Address - Street 2:
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778-9213
Practice Address - Country:US
Practice Address - Phone:787-942-8192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR679156FC0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact LensGroup - Single Specialty