Provider Demographics
NPI:1619732039
Name:CASAS BURGOS, MARISOL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARISOL
Middle Name:
Last Name:CASAS BURGOS
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 1:155 CALLE GUARIONEX
Mailing Address - Street 2:CIUDAD CENTRO LOS CACIQUES
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987
Mailing Address - Country:US
Mailing Address - Phone:939-339-6397
Mailing Address - Fax:
Practice Address - Street 1:CIUDAD CENTRO LOS CACIQUES
Practice Address - Street 2:CALLE GUARIONEX 155
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:939-339-6397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16904I207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine