1295743367 NPI number — DR. ERNESTO X MARRERO DE GRACIA M.D.

Table of content: DR. ERNESTO X MARRERO DE GRACIA M.D. (NPI 1295743367)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295743367 NPI number — DR. ERNESTO X MARRERO DE GRACIA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARRERO DE GRACIA
Provider First Name:
ERNESTO
Provider Middle Name:
X
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARRERO DE GRACIA
Provider Other First Name:
ERNESTO
Provider Other Middle Name:
X
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295743367
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
C/2 R-11
Provider Second Line Business Mailing Address:
SAN SOUCI
Provider Business Mailing Address City Name:
BAYAMON
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00957
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-599-1174
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
INSTITUTO SAN PABLO
Provider Second Line Business Practice Location Address:
SUITE 507 CALLE SANTA CRUZ #66
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-740-2010
Provider Business Practice Location Address Fax Number:
787-740-8377
Provider Enumeration Date:
08/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  15171 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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