MEDICARE: MARLANE PABON ORTEGA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	13330	PR

General Provider Information

NPI Number	:	1609322387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLANE PABON ORTEGA

Provider Business Mailing Address
First Line	:	PO BOX 9809
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00726-9809
Country	:	US
Telephone Number	:	787-704-0705
Fax Number	:	787-744-7444

Provider Business Practice Location Address
First Line	:	AVE PONCE DE LEON # 371
Second Line	:	OFICINA 410
City	:	SAN JUAN
State	:	PR
Zip	:	00915-3959
Country	:	US
Telephone Number	:	787-704-0705
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2016
Last Update Date	:	08/31/2016

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Directions to “ MARLANE PABON ORTEGA ” Practice Location

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