| Doctor Name: | MR. HERMENEGILDO MARCANO |
| NPI Number: | 1164655460 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MRC |
| License Number: | CCSS 115 |
| Business Practice Address: | Vistas De Rio Grande Ii Almacigo St. 540 Rio Grande, SC - 007458579 |
| Business Phone Number: | 7874138150 |
| Business Fax Number: | |
| Mailing Address: | Vistas De Rio Grande Ii Almacigo Street 540, RIO GRANDE |
| State: | PR |
| Postal Code: | 007458579 |
| Phone Number: | 7874138150 |
| Fax Number: | |
| NPI Enumeration Date: | 09/02/2009 |
| NPI Last Update Date: | 09/02/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | CCSS 115 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PW |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |