Provider Demographics
NPI:1275668592
Name:MARIN, CAROLE JEANIENE (MD)
Entity Type:Individual
Prefix:MRS
First Name:CAROLE
Middle Name:JEANIENE
Last Name:MARIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10929 SOUTH ST
Mailing Address - Street 2:SUITE 208B
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-5340
Mailing Address - Country:US
Mailing Address - Phone:562-924-5526
Mailing Address - Fax:562-924-1010
Practice Address - Street 1:10929 SOUTH ST
Practice Address - Street 2:SUITE 208B
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-5340
Practice Address - Country:US
Practice Address - Phone:562-924-5526
Practice Address - Fax:562-924-1010
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA234692084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry