Provider Demographics
NPI:1376746230
Name:MARRERO-CLEMENTE, GISELLE MARIE (MD)
Entity type:Individual
Prefix:MRS
First Name:GISELLE
Middle Name:MARIE
Last Name:MARRERO-CLEMENTE
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:MEDICAL OFFICE BUILDING
Mailing Address - Street 2:252 CALLE SAN JORGE SUITE 406
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00912-3310
Mailing Address - Country:US
Mailing Address - Phone:787-726-0210
Mailing Address - Fax:787-728-5136
Practice Address - Street 1:AVE PONCE DE LEON
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00919
Practice Address - Country:US
Practice Address - Phone:787-758-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11350208000000X
KYTP8342080N0001X
PR172582080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics