Provider Demographics
NPI:1215668736
Name:PERSONENI, MARIETTA ALEJANDRA
Entity type:Individual
Prefix:
First Name:MARIETTA
Middle Name:ALEJANDRA
Last Name:PERSONENI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CALLE PALMA REAL
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-5805
Mailing Address - Country:US
Mailing Address - Phone:787-360-7580
Mailing Address - Fax:
Practice Address - Street 1:RIO PIEDRAS MEDICAL CENTER
Practice Address - Street 2:UNIVERSITY DISTRICT HOSPITAL
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-754-0101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-24
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1750530572207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology