Healthcare Provider Details

I. General information

NPI: 1639150246
Provider Name (Legal Business Name): CARLOS E MARRERO ORTIZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 CALLE BARCELO
BARRANQUITAS PR
00794-1776
US

IV. Provider business mailing address

8 CALLE BARCELO
BARRANQUITAS PR
00794-1776
US

V. Phone/Fax

Practice location:
  • Phone: 787-547-6557
  • Fax:
Mailing address:
  • Phone: 787-547-6557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number11083
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number11083
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: