MEDICARE: MRS. GISELLE MARIE MARRERO-CLEMENTE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080N0001X	Neonatal-Perinatal Medicine Physician	17258	PR
2	208000000X	Pediatrics Physician	11350	PR
3	2080N0001X	Neonatal-Perinatal Medicine Physician	TP834	KY
4	2080N0001X	Neonatal-Perinatal Medicine Physician	01094786A	IN
5	2080N0001X	Neonatal-Perinatal Medicine Physician	ME164901	FL

General Provider Information

NPI Number	:	1376746230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GISELLE MARIE MARRERO-CLEMENTE M.D.

Provider Business Mailing Address
First Line	:	MEDICAL OFFICE BUILDING
Second Line	:	252 CALLE SAN JORGE SUITE 406
City	:	SAN JUAN
State	:	PR
Zip	:	00912-3310
Country	:	US
Telephone Number	:	787-726-0210
Fax Number	:	787-728-5136

Provider Business Practice Location Address
First Line	:	AVE PONCE DE LEON
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00919
Country	:	US
Telephone Number	:	787-758-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	04/03/2026

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