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Individual

MARCELA JATIVA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
1356 STATE ROAD 60 E, LAKE WALES, FL 33853-4322
(863) 679-8888
Mailing address
1356 STATE ROAD 60 E, LAKE WALES, FL 33853-4322
(863) 679-8888

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME109816
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
003691200
FL
Enumeration date
05/16/2008
Last updated
10/27/2011
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