Provider Demographics
NPI:1043755895
Name:MARIN GARCIA, PEDRO ANTONIO (SA-C, RMA)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:ANTONIO
Last Name:MARIN GARCIA
Suffix:
Gender:M
Credentials:SA-C, RMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 31ST ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-2512
Mailing Address - Country:US
Mailing Address - Phone:727-608-9204
Mailing Address - Fax:
Practice Address - Street 1:3010 31ST ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-2512
Practice Address - Country:US
Practice Address - Phone:727-608-9204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16-746246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant