Healthcare Provider Details

I. General information

NPI: 1376747386
Provider Name (Legal Business Name): LUIS G MARRERO PEREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: LUIS G MARRERO PEREZ

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 05/11/2020
Certification Date: 05/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 CALLE WASHINGTON STE 409 29 WASHINGTON ST.
SAN JUAN PR
00907-1521
US

IV. Provider business mailing address

PO BOX 16273
SAN JUAN PR
00908-6273
US

V. Phone/Fax

Practice location:
  • Phone: 787-710-6266
  • Fax:
Mailing address:
  • Phone: 787-908-3828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number15629
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA105416
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME106368
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberA105416
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberME106368
License Number StateFL
# 6
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number15629
License Number StatePR
# 7
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberME106368
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberA105416
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number15629
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: