Healthcare Provider Details

I. General information

NPI: 1174528269
Provider Name (Legal Business Name): JUAN M MARRERO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 04/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE 3 FONT MARTELO
HUMACAO PR
00791
US

IV. Provider business mailing address

267 CALLE INGENIO HACIENDA MARGARITA
LUQUILLO PR
00773-3031
US

V. Phone/Fax

Practice location:
  • Phone: 787-852-2424
  • Fax:
Mailing address:
  • Phone: 787-314-5854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number11002
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: