Provider Demographics
NPI:1770595613
Name:MARRERO MAS, AWILDA J (MD)
Entity type:Individual
Prefix:
First Name:AWILDA
Middle Name:J
Last Name:MARRERO MAS
Suffix:
Gender:F
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:CALLE AA #13 PASEO REAL
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-292-3757
Mailing Address - Fax:
Practice Address - Street 1:AVE AMERICO MIRANDA OSTE 953
Practice Address - Street 2:
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-764-5694
Practice Address - Fax:787-764-5694
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9568207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E38594Medicare UPIN
PR81810MAMedicare ID - Type Unspecified