Healthcare Provider Details

I. General information

NPI: 1841728375
Provider Name (Legal Business Name): MARIMAR TORRES BARRETO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 AVE J T PINRO
SAN JUAN PR
00921-1102
US

IV. Provider business mailing address

CALLE 1 H-13 RIVERSIDE PARK
BAYAMON PR
00961
US

V. Phone/Fax

Practice location:
  • Phone: 787-782-2175
  • Fax: 787-775-4098
Mailing address:
  • Phone: 787-379-6680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number731-0419
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: