Provider Demographics
NPI:1184090805
Name:MARRERO, CANDIDA III
Entity type:Individual
Prefix:MRS
First Name:CANDIDA
Middle Name:
Last Name:MARRERO
Suffix:III
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3690 N 56TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-2278
Mailing Address - Country:US
Mailing Address - Phone:786-562-3156
Mailing Address - Fax:
Practice Address - Street 1:100 S BISCAYNE BLVD STE 3119
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-2011
Practice Address - Country:US
Practice Address - Phone:786-562-3156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL47-4808534171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator