Healthcare Provider Details

I. General information

NPI: 1588229223
Provider Name (Legal Business Name): THOMAS VICENTE MARRERO CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2019
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MAYAAGUEZ MEDICAL CENTER AVE 410 CARR 2 BO SABALO
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

URB JARDINES DEL PUERTO 4418 CALLE CRISTINA
CABO ROJO PR
00623
US

V. Phone/Fax

Practice location:
  • Phone: 787-652-9200
  • Fax:
Mailing address:
  • Phone: 787-445-6988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberAPRN11000860
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11000860
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: