Provider Demographics
NPI:1437355617
Name:MARRERO, DERIK IVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DERIK
Middle Name:IVAN
Last Name:MARRERO
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:B5 CALLE TABONUCO
Mailing Address - Street 2:SUITE 106 GALERIA SAN PATRICIO
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968-3004
Mailing Address - Country:US
Mailing Address - Phone:787-273-7000
Mailing Address - Fax:787-273-7019
Practice Address - Street 1:B5 CALLE TABONUCO
Practice Address - Street 2:SUITE 106 GALERIA SAN PATRICIO
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-3004
Practice Address - Country:US
Practice Address - Phone:787-273-7000
Practice Address - Fax:787-273-7019
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR173092086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery