Provider Demographics
NPI:1780085092
Name:MARRERO GONZALEZ, AMANDA PAOLA (MD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:PAOLA
Last Name:MARRERO GONZALEZ
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:PO BOX 19120
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-1120
Mailing Address - Country:US
Mailing Address - Phone:787-625-1446
Mailing Address - Fax:
Practice Address - Street 1:1462 PROFESOR AUGUSTO RODRIGUEZ ST.
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909
Practice Address - Country:US
Practice Address - Phone:787-625-1446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-07
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD905092085R0202X
PR222572085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC012072154Medicaid
MD225294500Medicaid