Healthcare Provider Details

I. General information

NPI: 1457387573
Provider Name (Legal Business Name): CARMEN M MARRERO RODRIGUEZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 09/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE FERNANDEZ JUNCOS PTA DE TIERRA #364
SAN JUAN PR
00906
US

IV. Provider business mailing address

PO BOX 9020383
SAN JUAN PR
00902-0383
US

V. Phone/Fax

Practice location:
  • Phone: 787-721-7413
  • Fax:
Mailing address:
  • Phone: 787-721-7413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State

VIII. Authorized Official

Name: CARMEN M MARRERO-RODRIGUEZ
Title or Position: ADMINISTRADORA
Credential:
Phone: 787-449-7463