Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 22321 | PR |
N | 208D00000X | General Practice Physician | 22321 | PR |
NPI | 1043771652 |
---|---|
Provider Name | Stephanie Marie Marrero-Borrero |
First Address | Ponce, PR 00733-5494 |
Second Address | Ponce, PR 00733 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2019 |
Last Update Date | 03/11/2021 |