Provider Demographics
NPI:1023051844
Name:CDT DR. MARRERO
Entity type:Organization
Organization Name:CDT DR. MARRERO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:I
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-878-5534
Mailing Address - Street 1:PO BOX 1905
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-1905
Mailing Address - Country:US
Mailing Address - Phone:787-878-5534
Mailing Address - Fax:787-878-5570
Practice Address - Street 1:54 CALLETENIENTE GARCIA
Practice Address - Street 2:ARECIBO GARDENS
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4261
Practice Address - Country:US
Practice Address - Phone:787-878-5534
Practice Address - Fax:787-878-5570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR137261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR31055Medicaid
PR31055Medicaid
PRE24338Medicare UPIN