Provider Demographics
NPI:1023418514
Name:MARRERO ALFONZO, RAQUEL (MS PHL)
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:
Last Name:MARRERO ALFONZO
Suffix:
Gender:F
Credentials:MS PHL
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 1035
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-1035
Mailing Address - Country:US
Mailing Address - Phone:787-597-6367
Mailing Address - Fax:
Practice Address - Street 1:CARR 2 KM 92.3 BO MEMBRILLO CAMUY
Practice Address - Street 2:
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627
Practice Address - Country:US
Practice Address - Phone:787-597-6367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-03
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4148235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist