Provider Demographics
NPI:1114973476
Name:MARRERO - RIVERA, MIGUEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:A
Last Name:MARRERO - RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT. ANESTESIOLOGIA
Mailing Address - Street 2:PO BOX 365067
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4330
Mailing Address - Country:US
Mailing Address - Phone:787-758-0640
Mailing Address - Fax:787-758-1327
Practice Address - Street 1:ANESTHESIOLOGY DEPARTMENT SUITE 983
Practice Address - Street 2:MEDICAL SCIENCES CAMPUS UPR
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936
Practice Address - Country:US
Practice Address - Phone:787-758-0640
Practice Address - Fax:787-758-1327
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11489207L00000X, 207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE08240Medicare UPIN