Healthcare Provider Details

I. General information

NPI: 1538355599
Provider Name (Legal Business Name): AILIS MARRERO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2007
Last Update Date: 01/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7040 LAND O LAKES BLVD STE 103
LAND O LAKES FL
34638-3232
US

IV. Provider business mailing address

7040 LAND O LAKES BLVD STE 103
LAND O LAKES FL
34638-3232
US

V. Phone/Fax

Practice location:
  • Phone: 813-929-5330
  • Fax:
Mailing address:
  • Phone: 813-929-5330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME 99818
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: