Provider Demographics
NPI:1821778689
Name:SMM HEALTHCARE PROVIDER LLC
Entity Type:Organization
Organization Name:SMM HEALTHCARE PROVIDER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SYLMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARRERO MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-412-0002
Mailing Address - Street 1:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-0215
Mailing Address - Country:US
Mailing Address - Phone:787-412-0002
Mailing Address - Fax:
Practice Address - Street 1:1507 AVE PONCE DE LEON
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-1750
Practice Address - Country:US
Practice Address - Phone:939-475-1414
Practice Address - Fax:939-475-1422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-18
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty