Healthcare Provider Details

I. General information

NPI: 1720111537
Provider Name (Legal Business Name): MIGUEL ANGEL MARRERO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9685 VIA EXCELENCIA STE 102
SAN DIEGO CA
92126-7500
US

IV. Provider business mailing address

9685 VIA EXCELENCIA STE 102
SAN DIEGO CA
92126-7500
US

V. Phone/Fax

Practice location:
  • Phone: 619-333-3959
  • Fax: 619-333-6005
Mailing address:
  • Phone: 619-333-3959
  • Fax: 619-333-6005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberMD046545L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number165337
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: