MEDICARE: MISS GISELLE MARIE PAGAN MARRERO MD

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	208D00000X	General Practice Physician	35666	PR
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207V00000X	Obstetrics & Gynecology Physician	78498	AZ

General Provider Information

NPI Number	:	1588229587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS GISELLE MARIE PAGAN MARRERO MD

Provider Business Mailing Address
First Line	:	PO BOX 6730
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85246-6730
Country	:	US
Telephone Number	:	480-821-3600
Fax Number	:	480-857-2667

Provider Business Practice Location Address
First Line	:	917 AVE TITO CASTRO
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00716-4717
Country	:	US
Telephone Number	:	787-844-2080
Fax Number	:

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

Provider Enumeration Date	:	05/06/2019
Last Update Date	:	04/16/2026

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