Provider Demographics
NPI:1114033941
Name:BLASINI RIVERA, MARINO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARINO
Middle Name:
Last Name:BLASINI RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CIRUGIA RCM
Mailing Address - Street 2:PO BOX 29134
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929-0134
Mailing Address - Country:US
Mailing Address - Phone:787-763-2440
Mailing Address - Fax:
Practice Address - Street 1:CLINICA DE LA ESCUELA DE MEDICINA
Practice Address - Street 2:REPARTO METROPOLITANO SHOPPING, AVE. AMERICO MIRANDA
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-758-7910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1364208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR90117OtherTRIPLE S