Provider Demographics
NPI:1255501755
Name:MARIN, KIMBERLY A (AP, RD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:MARIN
Suffix:
Gender:F
Credentials:AP, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12651 W SUNRISE BLVD
Mailing Address - Street 2:#202
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-0906
Mailing Address - Country:US
Mailing Address - Phone:954-835-2345
Mailing Address - Fax:954-838-9192
Practice Address - Street 1:12651 W SUNRISE BLVD
Practice Address - Street 2:#202
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-0906
Practice Address - Country:US
Practice Address - Phone:954-835-2345
Practice Address - Fax:954-838-9192
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND3274133V00000X
FLAP2392171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered