Basic Information
| Provider Information | |||||||||
| NPI: | 1376746230 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARRERO-CLEMENTE | ||||||||
| FirstName: | GISELLE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | MEDICAL OFFICE BUILDING | ||||||||
| Address2: | 252 CALLE SAN JORGE SUITE 406 | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009123310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877260210 | ||||||||
| FaxNumber: | 7877285136 | ||||||||
| Practice Location | |||||||||
| Address1: | AVE PONCE DE LEON | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877582000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2007 | ||||||||
| LastUpdateDate: | 10/31/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 11350 | PR | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080N0001X | 17258 | PR | Y | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
No ID Information.