Healthcare Provider Details

I. General information

NPI: 1053365155
Provider Name (Legal Business Name): JEANNETTE MORALES MARRERO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 CALLE GUAMANI LOS CAMPOS DE MONTE HIEDRA
SAN JUAN PR
00926
US

IV. Provider business mailing address

732 CALLE GUAMANI LOS CAMPOS DE MONTE HIEDRA
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-644-0270
  • Fax: 787-728-5136
Mailing address:
  • Phone: 787-644-0270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12571
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: