Provider Demographics
NPI:1326380932
Name:MARMOLEJOS, CARMEN L
Entity Type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:L
Last Name:MARMOLEJOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5190 NW 167TH ST
Mailing Address - Street 2:SUITE 216
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-6328
Mailing Address - Country:US
Mailing Address - Phone:305-624-4114
Mailing Address - Fax:305-624-4319
Practice Address - Street 1:5190 NW 167TH ST
Practice Address - Street 2:SUITE 216
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-6328
Practice Address - Country:US
Practice Address - Phone:305-624-4114
Practice Address - Fax:305-624-4319
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant