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General NPI Number Information
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NPI Number | 1780085092
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Entity Type | Individual
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Provider Name | AMANDA PAOLA MARRERO GONZALEZ MD
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Gender | Female
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Dates
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Enumeration Date | 09/07/2014
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Last Update Date | 10/26/2022
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Provider Practice Location Address
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Address Line | 1462 PROFESOR AUGUSTO RODRIGUEZ ST.
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City | SAN JUAN
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State | PR
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Zip | 00909
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Country | US
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Telephone | 787-625-1446
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 19120
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City | SAN JUAN
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State | PR
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Zip | 00910-1120
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Country | US
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Telephone | 787-625-1446
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | D90509
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 22257
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License Number State | PR
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