1386625705 NPI number — DRA CARMEN M MARRERO PSC

Table of content: (NPI 1386625705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386625705 NPI number — DRA CARMEN M MARRERO PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRA CARMEN M MARRERO PSC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GRUPO DE SERVICIOS GERIATRICOS
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386625705
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
488 CARR 845
Provider Second Line Business Mailing Address:
URB PURPLE TREE
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00926-4403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-761-1943
Provider Business Mailing Address Fax Number:
787-761-1947

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
488 CARR 845
Provider Second Line Business Practice Location Address:
URB PURPLE TREE
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00926-4403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-761-1943
Provider Business Practice Location Address Fax Number:
787-761-1947
Provider Enumeration Date:
11/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MARRERO
Authorized Official First Name:
CARMEN
Authorized Official Middle Name:
MILAGROS
Authorized Official Title or Position:
PRESIDENT OF CORPORATION
Authorized Official Telephone Number:
787-761-1943

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QG0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 20085 . This is a "PREFERRED HEALTH UTI" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 4214 . This is a "INTL MEDICAL CARD" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 9280057 . This is a "HUMANA INSURANCE OF PR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1386625705 . This is a "MCS CLASSICARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1386625705 . This is a "HUMANA MEDICARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 81953 . This is a "MEDICARE OPTIMO" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1386625705 . This is a "MCS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1386625705 . This is a "PALIC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 2758 . This is a "PREFERRED MEDICARE CHOICE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 9280057 . This is a "HUMANA HEALTH PLANS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 069435 . This is a "CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1386625705 . This is a "MAPFRE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1386625705 . This is a "OPTION HEALTH CARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 500168E . This is a "MEDICARE Y MUCHO MAS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 81953 . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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