Provider Demographics
NPI:1013978246
Name:MARRERO NIEVES, JOSE ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ANTONIO
Last Name:MARRERO NIEVES
Suffix:
Gender:M
Credentials:MD
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 1905
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-1905
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:54 CALLE TNTE LUIS GARCIA
Practice Address - Street 2:URB. ARECIBO GARDENS
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4261
Practice Address - Country:US
Practice Address - Phone:787-878-5534
Practice Address - Fax:787-878-5570
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8433208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
E24338Medicare UPIN
PR80968Medicare PIN