Provider Demographics
NPI:1063880458
Name:ANGELITA MARRERO
Entity type:Organization
Organization Name:ANGELITA MARRERO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPPORTIVE LIVING COACH
Authorized Official - Prefix:
Authorized Official - First Name:ANGELITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARRERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-272-2172
Mailing Address - Street 1:PO BOX 1123
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32721-1123
Mailing Address - Country:US
Mailing Address - Phone:407-272-2172
Mailing Address - Fax:
Practice Address - Street 1:924 HUNTERS CREEK DR APT 101
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-0947
Practice Address - Country:US
Practice Address - Phone:407-272-2172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service