Provider Demographics
NPI:1356972822
Name:GIRON BRAVO, MARLENE MARIA
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:MARIA
Last Name:GIRON BRAVO
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 1:1 VIA PEDREGAL APT 901
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-6610
Mailing Address - Country:US
Mailing Address - Phone:787-600-9692
Mailing Address - Fax:
Practice Address - Street 1:1 VIA PEDREGAL APT 901
Practice Address - Street 2:
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-6610
Practice Address - Country:US
Practice Address - Phone:787-600-9692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program