Healthcare Provider Details

I. General information

NPI: 1750135182
Provider Name (Legal Business Name): ANDREA ESTEFANIA MARRERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA ESTEFANIA MARRERO PENA

II. Dates (important events)

Enumeration Date: 04/12/2024
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7621 W RIDGEWOOD DR STE 914B
PARMA OH
44129-5537
US

IV. Provider business mailing address

955 W SAINT CLAIR AVE APT 1115
CLEVELAND OH
44113-1238
US

V. Phone/Fax

Practice location:
  • Phone: 216-282-1448
  • Fax:
Mailing address:
  • Phone: 305-440-6889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN32145
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30028590
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: