Provider Demographics
NPI:1689028706
Name:GONZALEZ MARRERO, MARICELY XIOMARY (NURSE)
Entity Type:Individual
Prefix:
First Name:MARICELY
Middle Name:XIOMARY
Last Name:GONZALEZ MARRERO
Suffix:
Gender:F
Credentials:NURSE
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 147
Mailing Address - Street 2:
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766-0147
Mailing Address - Country:US
Mailing Address - Phone:787-709-4130
Mailing Address - Fax:
Practice Address - Street 1:B-5 AVE GAUTIER BENITEZ ANEXO
Practice Address - Street 2:CONSOLIDATED MALL
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:939-242-7726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR34301163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse