Healthcare Provider Details

I. General information

NPI: 1982965240
Provider Name (Legal Business Name): JESSICA C. MARRERO-ROLON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2012
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

B 23 CALLE 3 URBANIZACION FLAMBOYAN
MANATI PR
00674
US

IV. Provider business mailing address

MANATI MEDICAL CENTER, DEPARTAMENTO MEDICINA DE FAMILIA P.O. BOX 1142
MANATI PR
00674-1142
US

V. Phone/Fax

Practice location:
  • Phone: 787-855-4011
  • Fax: 787-855-4014
Mailing address:
  • Phone: 787-621-3700
  • Fax: 787-855-4014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18189
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: