Provider Demographics
NPI:1306940481
Name:MARMOLEJO, ALEJANDRO MAYOBANEX (MD)
Entity type:Individual
Prefix:DR
First Name:ALEJANDRO
Middle Name:MAYOBANEX
Last Name:MARMOLEJO
Suffix:
Gender:M
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:J1 CALLE 5 URB HILLSIDE
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5225
Mailing Address - Country:US
Mailing Address - Phone:787-720-4043
Mailing Address - Fax:
Practice Address - Street 1:J1 5 STREET URB HILLSIDE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-5225
Practice Address - Country:US
Practice Address - Phone:787-720-4043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10598208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF47589Medicare UPIN
PR82875Medicare ID - Type UnspecifiedPROVIDER