Healthcare Provider Details

I. General information

NPI: 1649271008
Provider Name (Legal Business Name): JEANNETTE MARRERO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 CALLE JULIO CINTRON SUITE 220 BOX. 152
AIBONITO PR
00705-3312
US

IV. Provider business mailing address

202 CALLE JULIO CINTRON SUITE 220 BOX. 152
AIBONITO PR
00705-3312
US

V. Phone/Fax

Practice location:
  • Phone: 787-735-0377
  • Fax: 787-735-0377
Mailing address:
  • Phone: 787-735-0377
  • Fax: 787-735-0377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number10341
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: