Provider Demographics
NPI:1720111537
Name:MARRERO, MIGUEL ANGEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:ANGEL
Last Name:MARRERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9685 VIA EXCELENCIA STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-7500
Mailing Address - Country:US
Mailing Address - Phone:619-333-3959
Mailing Address - Fax:619-333-6005
Practice Address - Street 1:9685 VIA EXCELENCIA STE 102
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-7500
Practice Address - Country:US
Practice Address - Phone:619-333-3959
Practice Address - Fax:619-333-6005
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD046545L207VE0102X
CA165337207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE57024Medicare UPIN