Provider Demographics
NPI:1376747386
Name:MARRERO PEREZ, LUIS G
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:G
Last Name:MARRERO PEREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:LUIS
Other - Middle Name:G
Other - Last Name:MARRERO PEREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 16273
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00908-6273
Mailing Address - Country:US
Mailing Address - Phone:787-908-3828
Mailing Address - Fax:
Practice Address - Street 1:29 CALLE WASHINGTON STE 409
Practice Address - Street 2:29 WASHINGTON ST.
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1521
Practice Address - Country:US
Practice Address - Phone:787-710-6266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15629207X00000X, 207XS0117X, 207XX0005X
CAA105416207X00000X, 207XS0117X, 207XX0005X
FLME106368207X00000X, 207XS0117X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine