MEDICARE: DERIK I. MARRERO AMADEO M.D., LLC

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	208200000X	Plastic Surgery Physician	17309	PR

General Provider Information

NPI Number	:	1851714497
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DERIK I. MARRERO AMADEO M.D., LLC

Provider Business Mailing Address
First Line	:	B5 CALLE TABONUCO
Second Line	:	STE 106 GALERIA SAN PATRICIO
City	:	GUAYNABO
State	:	PR
Zip	:	00968-3004
Country	:	US
Telephone Number	:	787-273-0000
Fax Number	:	787-273-7019

Provider Business Practice Location Address
First Line	:	310 AVE LOMAS VERDES
Second Line	:	SUITE 202
City	:	SAN JUAN
State	:	PR
Zip	:	00927-6638
Country	:	US
Telephone Number	:	787-272-5000
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. DERIK IVAN MARRERO
Credential	:	M.D.
Telephone Number	:	787-273-7000

Provider Enumeration Date	:	02/03/2014
Last Update Date	:	10/13/2021

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