Provider Demographics
NPI:1568569879
Name:MARRERO-HERNANDEZ, CARMEN I
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:I
Last Name:MARRERO-HERNANDEZ
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:PO BOX 1357
Mailing Address - Street 2:
Mailing Address - City:CIALES
Mailing Address - State:PR
Mailing Address - Zip Code:00638-1357
Mailing Address - Country:US
Mailing Address - Phone:787-884-4809
Mailing Address - Fax:
Practice Address - Street 1:CARR. 149 KM 9.0
Practice Address - Street 2:BO. RIO ARRIBA
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-884-4809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1766OtherINTERNATIONAL MEDICAL CAR
PR296155021OtherASOCIACION DE MAESTROS
PR50538OtherPREFERRED MEDICARE CHOISE
PR824968OtherMMM
PR89212OtherTRIPLE SSS
PRX2227OtherCRUZ AZUL
PR50538OtherPREFERRED MEDICARE CHOISE
PRF62631Medicare UPIN