Provider Demographics
NPI:1922735992
Name:OVALLE MARRERO, VICTOR ENRIQUE (PA-C)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:ENRIQUE
Last Name:OVALLE MARRERO
Suffix:
Gender:M
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:10664 BLOOMING CT
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41051-1106
Mailing Address - Country:US
Mailing Address - Phone:904-635-5105
Mailing Address - Fax:
Practice Address - Street 1:2000 JOSEPH E SANKER BLVD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212-1979
Practice Address - Country:US
Practice Address - Phone:513-841-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant