Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 8381 | PR |
NPI | 1083774228 |
---|---|
Provider Name | Carlos C Marrero SR. |
First Address | San Juan, PR 00936-6268 |
Second Address | San Juan, PR 00918 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
066733 | CRUZ AZUL (01) | |
1808 | PALIC-PE (01) | |
27803MA | TS (01) | |
28381 | MCS (01) | |
58376947 | CIGNA (01) | |
9180014 | HUMANA (01) | |
E66290 | (02) |