Basic Information
| Provider Information | |||||||||
| NPI: | 1215164926 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARRERO | ||||||||
| FirstName: | CARMEN | ||||||||
| MiddleName: | MARIA | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1395 NW 167TH ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI GARDENS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331695710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612932900 | ||||||||
| FaxNumber: | 5614125554 | ||||||||
| Practice Location | |||||||||
| Address1: | 4998 10TH AVE N | ||||||||
| Address2: | |||||||||
| City: | GREENACRES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334632210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612932900 | ||||||||
| FaxNumber: | 5614125554 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2009 | ||||||||
| LastUpdateDate: | 10/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS 10657 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.