Healthcare Provider Details

I. General information

NPI: 1023051844
Provider Name (Legal Business Name): CDT DR. MARRERO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 CALLETENIENTE GARCIA ARECIBO GARDENS
ARECIBO PR
00612-4261
US

IV. Provider business mailing address

PO BOX 1905
ARECIBO PR
00613-1905
US

V. Phone/Fax

Practice location:
  • Phone: 787-878-5534
  • Fax: 787-878-5570
Mailing address:
  • Phone: 787-878-5534
  • Fax: 787-878-5570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number137
License Number StatePR

VIII. Authorized Official

Name: MRS. ANA I. GARCIA
Title or Position: OFFICE SUPERVISOR
Credential:
Phone: 787-878-5534