Provider Demographics
NPI:1538976030
Name:MARRERO, MARIOLA S
Entity type:Individual
Prefix:
First Name:MARIOLA
Middle Name:S
Last Name:MARRERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CHALETS DE ROYAL PALM
Mailing Address - Street 2:EDIF 9 APT 907
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-3027
Mailing Address - Country:US
Mailing Address - Phone:787-677-1481
Mailing Address - Fax:
Practice Address - Street 1:URB PEREZ MORRIS
Practice Address - Street 2:#1 CALLE PONCE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00957
Practice Address - Country:US
Practice Address - Phone:787-677-1481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR007602235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR007602OtherLICENCIA