Provider Demographics
NPI:1578762852
Name:ALICEA, MIRIAM MARRERO (MD)
Entity Type:Individual
Prefix:MISS
First Name:MIRIAM
Middle Name:MARRERO
Last Name:ALICEA
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:COTTO STATION
Mailing Address - Street 2:APARTADO 9621
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613
Mailing Address - Country:US
Mailing Address - Phone:787-878-3209
Mailing Address - Fax:787-879-8867
Practice Address - Street 1:PONCE DE LEON #52
Practice Address - Street 2:URB GARCIA
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-879-8867
Practice Address - Fax:787-879-8867
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12170208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR88662Medicaid
G42492Medicare UPIN