Provider Demographics
NPI:1851714497
Name:DERIK I. MARRERO AMADEO M.D., LLC
Entity Type:Organization
Organization Name:DERIK I. MARRERO AMADEO M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DERIK
Authorized Official - Middle Name:IVAN
Authorized Official - Last Name:MARRERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-273-7000
Mailing Address - Street 1:B5 CALLE TABONUCO
Mailing Address - Street 2:STE 106 GALERIA SAN PATRICIO
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968-3004
Mailing Address - Country:US
Mailing Address - Phone:787-273-0000
Mailing Address - Fax:787-273-7019
Practice Address - Street 1:310 AVE LOMAS VERDES
Practice Address - Street 2:SUITE 202
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-6638
Practice Address - Country:US
Practice Address - Phone:787-272-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-03
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17309208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty