Healthcare Provider Details

I. General information

NPI: 1700647237
Provider Name (Legal Business Name): LADY MAR MARRERO AULET
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 616 KM 0.1 BARRIO TIERRAS NUEVAS
MANATI PR
00674
US

IV. Provider business mailing address

PO BOX 1046
MANATI PR
00674-1046
US

V. Phone/Fax

Practice location:
  • Phone: 787-549-9590
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: