Healthcare Provider Details

I. General information

NPI: 1942673199
Provider Name (Legal Business Name): MARILYN ESTREMERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2015
Last Update Date: 11/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EDIFICIO COMERCIAL CATALANA #66
BARCELONETA PR
00617
US

IV. Provider business mailing address

C.S.P P.O BOX 2020 PMB 288
BARCELONETA PR
00617
US

V. Phone/Fax

Practice location:
  • Phone: 787-915-3000
  • Fax:
Mailing address:
  • Phone: 787-215-7625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number857
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: