Healthcare Provider Details

I. General information

NPI: 1083793673
Provider Name (Legal Business Name): LAURA MARRERO PUIG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 05/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO. CARACOLES CARRT. 402 KM 4.2
ANASCO PR
00610
US

IV. Provider business mailing address

RR 4 BOX 16460
ANASCO PR
00610-9595
US

V. Phone/Fax

Practice location:
  • Phone: 787-826-7626
  • Fax: 787-826-7626
Mailing address:
  • Phone: 787-519-1555
  • Fax: 787-826-2871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number14718
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: