Provider Demographics
NPI:1053666719
Name:MARIN, JOSE ALBERTO (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ALBERTO
Last Name:MARIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13001 EASTLAKE BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79928-6312
Mailing Address - Country:US
Mailing Address - Phone:915-248-2345
Mailing Address - Fax:866-726-3556
Practice Address - Street 1:13001 EASTLAKE BLVD STE 105-106
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79928-6311
Practice Address - Country:US
Practice Address - Phone:915-248-2345
Practice Address - Fax:667-263-5568
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2014-0967207Q00000X
TXQ3405207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine