Basic Information
| Provider Information | |||||||||
| NPI: | 1689028706 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GONZALEZ MARRERO | ||||||||
| FirstName: | MARICELY | ||||||||
| MiddleName: | XIOMARY | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | NURSE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 147 | ||||||||
| Address2: | |||||||||
| City: | VILLALBA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007660147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877094130 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | B-5 AVE GAUTIER BENITEZ ANEXO | ||||||||
| Address2: | CONSOLIDATED MALL | ||||||||
| City: | CAGUAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9392427726 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2016 | ||||||||
| LastUpdateDate: | 04/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 34301 | PR | Y | Nursing Service Providers | Registered Nurse |
No ID Information.