1851714497 NPI number — DERIK I. MARRERO AMADEO M.D., LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851714497 NPI number — DERIK I. MARRERO AMADEO M.D., LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DERIK I. MARRERO AMADEO M.D., LLC
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:
Provider Other Organization Name Type Code:
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:
1851714497
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 AVE LOMAS VERDES
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00927-6638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-272-5000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/03/2014

Additional Information

Authorized Official

Authorized Official Last Name:
MARRERO
Authorized Official First Name:
DERIK
Authorized Official Middle Name:
IVAN
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
787-273-7000

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  17309 , 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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