Provider Demographics
NPI:1619973344
Name:CORREA MARRA, SONIA M
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:M
Last Name:CORREA MARRA
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 373026
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737-3026
Mailing Address - Country:US
Mailing Address - Phone:787-263-5752
Mailing Address - Fax:
Practice Address - Street 1:CARR 1 KM 58.9
Practice Address - Street 2:BO QUEBRADA ARRIBA
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-263-5752
Practice Address - Fax:787-263-5753
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12270207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH39736Medicare UPIN
PR0020216Medicare ID - Type Unspecified