Healthcare Provider Details

I. General information

NPI: 1083562458
Provider Name (Legal Business Name): MARLENE DUCHATELIER CHARLES PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARLENE DUCHATELIER PA

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COND DELICIAS
SAN JUAN PR
00907-2859
US

IV. Provider business mailing address

1215 SEA PINES WAY
LANTANA FL
33462-4248
US

V. Phone/Fax

Practice location:
  • Phone: 787-579-4702
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2858PA
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: