Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 8433 | PR |
NPI | 1013978246 |
---|---|
Provider Name | Dr. Jose Antonio Marrero Nieves |
First Address | Arecibo, PR 00613-1905 |
Second Address | Arecibo, PR 00612-4261 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2006 |
Last Update Date | 14/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E24338 | (02) |