Provider Demographics
NPI:1518671619
Name:RODOLFO ESTREMERA MARCIAL LLC
Entity type:Organization
Organization Name:RODOLFO ESTREMERA MARCIAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTREMERA MARCIAL
Authorized Official - Suffix:
Authorized Official - Credentials:ME
Authorized Official - Phone:939-338-0793
Mailing Address - Street 1:PANORAMA K-5 TERRAZAS DE CARRAIZO
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-0000
Mailing Address - Country:US
Mailing Address - Phone:787-233-3131
Mailing Address - Fax:
Practice Address - Street 1:1801 SANTURCE MEDICAL MALL
Practice Address - Street 2:SUITE 409-410
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00919
Practice Address - Country:US
Practice Address - Phone:939-338-0793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-12
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty