Provider Demographics
NPI:1053302802
Name:DRA EDITH M MARRERO CSP
Entity type:Organization
Organization Name:DRA EDITH M MARRERO CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARRERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-787-6090
Mailing Address - Street 1:34 CALLE VIOLETA
Mailing Address - Street 2:CIUCAD SARDIN III
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-4866
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:787-740-3816
Practice Address - Street 1:AG1 AVE LOMAS VERDES
Practice Address - Street 2:SANTA JUANITA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-4740
Practice Address - Country:US
Practice Address - Phone:787-787-6090
Practice Address - Fax:787-740-3816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty