Healthcare Provider Details

I. General information

NPI: 1063987279
Provider Name (Legal Business Name): MICHELLE MARIE MARQUEZ ROSARIO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2018
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 188 # 187
LOIZA PR
00772-1850
US

IV. Provider business mailing address

#64B GOYCO STREET
CAGUAS PR
00725
US

V. Phone/Fax

Practice location:
  • Phone: 787-876-2042
  • Fax: 787-256-1900
Mailing address:
  • Phone: 787-746-2530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number22356
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34968
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15245-I
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number22356
License Number StatePR
# 5
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number22356
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: