Provider Demographics
NPI:1578688750
Name:MARCANO-ORTIZ, MARIE CARMEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:CARMEN
Last Name:MARCANO-ORTIZ
Suffix:
Gender:F
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 777
Mailing Address - Street 2:
Mailing Address - City:PERIDOT
Mailing Address - State:AZ
Mailing Address - Zip Code:85542-0777
Mailing Address - Country:US
Mailing Address - Phone:928-961-1995
Mailing Address - Fax:
Practice Address - Street 1:Y24 AVE L MUNOZ MARIN
Practice Address - Street 2:URB. MARIOLGA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:939-579-0155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2018-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16587208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice