Provider Demographics
NPI:1992787048
Name:MARRERO, CARMEN MILAGROS (MD)
Entity type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:MILAGROS
Last Name:MARRERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:CARMEN
Other - Middle Name:MILAGROS
Other - Last Name:MARRERO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSC
Mailing Address - Street 1:488 CARR 845
Mailing Address - Street 2:URB PURPLE TREE
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4403
Mailing Address - Country:US
Mailing Address - Phone:787-761-1945
Mailing Address - Fax:787-761-1947
Practice Address - Street 1:488 CARR 845
Practice Address - Street 2:URB PURPLE TREE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-4403
Practice Address - Country:US
Practice Address - Phone:787-761-1945
Practice Address - Fax:787-761-1947
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9548207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR069435OtherCRUZ AZUL
PR660563176OtherUNITED HEALTH CARE
PR660563176OtherPALIC
PR81953OtherTRIPLE S (SSS)
PR660563176OtherCOSVI
PR660563176OtherSALUD DORADO CON MEDICARE
PR81953OtherMEDICARE OPTIMO
PR20085OtherPREFERRED HEALTH (UTI)
PR660563176OtherMAPFRE L.
PR660563176OtherOPTION HEALTH CARE
PR660563176OtherMEDICAL CARD SYSTEM (MCS)
PR660563176OtherMCS CLASSICARE
PR660563176OtherFIRST PLUS
PR9280057OtherHUMANA HEALTH PLANS
PR500168EOtherMEDICARE Y MUCHO MAS (MMM
PR660563176OtherAUXILIO PLATINO
PR9280057OtherHUMANA INSURANCE OF PR
PR2758OtherPREFERRED MEDICARE CHOICE
PR4214OtherINTERNATIONAL MEDICAL CAR
PR9280057OtherHUMANA HEALTH PLANS