Healthcare Provider Details

I. General information

NPI: 1255541082
Provider Name (Legal Business Name): MIGUEL ANGEL MARRERO JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 AVE LAUREL SANTA JUANITA
BAYAMON PR
00956-4816
US

IV. Provider business mailing address

1140 CALLE MALLORCA MANSIONES VISTAMAR MARINA
CAROLINA PR
00983-1580
US

V. Phone/Fax

Practice location:
  • Phone: 787-787-5151
  • Fax:
Mailing address:
  • Phone: 787-768-7557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number14694
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: