Provider Demographics
NPI:1245358118
Name:MARRERO ORTIZ, SANDRA ENID (MD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:ENID
Last Name:MARRERO ORTIZ
Suffix:
Gender:F
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:RIO HONDO 2
Mailing Address - Street 2:AK-12 RIO JAJOME
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-360-2973
Mailing Address - Fax:
Practice Address - Street 1:1995 CARR 2 STE 2401
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-5056
Practice Address - Country:US
Practice Address - Phone:787-753-3412
Practice Address - Fax:787-753-3413
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12523208600000X
FLME1265102086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME126510OtherFLORIDA MEDICAL LICENCE
PRG46680Medicare UPIN