Provider Demographics
NPI:1093828162
Name:MARIN, DEBBIE (LM)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:
Last Name:MARIN
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-6708
Mailing Address - Country:US
Mailing Address - Phone:954-925-4499
Mailing Address - Fax:954-925-2756
Practice Address - Street 1:2315 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-6708
Practice Address - Country:US
Practice Address - Phone:954-925-4499
Practice Address - Fax:954-925-2756
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW 44176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL246233OtherAVMED DEBBIE
FL22953OtherNHP
FL293433OtherAMERIGROUP
FL5123292OtherAETNA
FLB0109OtherBC/BS
FLN275093OtherSTAYWELL DEBBIE
FL225901OtherAMERIGROUP DEBBIE
FLN170517OtherSTAYWELL
FL237106OtherAVMED