Provider Demographics
NPI:1518973411
Name:MARRERO, RAFAEL LUIS (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:LUIS
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:PO BOX 1438
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-1438
Mailing Address - Country:US
Mailing Address - Phone:787-735-1075
Mailing Address - Fax:787-735-5572
Practice Address - Street 1:CALLE PEDRO ROSARIO NUM.20
Practice Address - Street 2:EDIFICIO AIBONITO PLAZA SUITE C
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-1438
Practice Address - Country:US
Practice Address - Phone:787-735-1075
Practice Address - Fax:787-735-5572
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2024-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10662207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR82965Medicare ID - Type Unspecified
PRF31816Medicare UPIN