Healthcare Provider Details

I. General information

NPI: 1053302802
Provider Name (Legal Business Name): DRA EDITH M MARRERO CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2005
Last Update Date: 09/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AG1 AVE LOMAS VERDES SANTA JUANITA
BAYAMON PR
00956-4740
US

IV. Provider business mailing address

34 CALLE VIOLETA CIUCAD SARDIN III
TOA ALTA PR
00953-4866
US

V. Phone/Fax

Practice location:
  • Phone: 787-787-6090
  • Fax: 787-740-3816
Mailing address:
  • Phone:
  • Fax: 787-740-3816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: EDITH M MARRERO
Title or Position: PRESIDENT
Credential: MD
Phone: 787-787-6090