Provider Demographics
NPI:1346316833
Name:PORTNEY, MARINA MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:MICHELLE
Last Name:PORTNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:810 S DURANGO DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-2423
Mailing Address - Country:US
Mailing Address - Phone:702-240-0874
Mailing Address - Fax:702-240-3627
Practice Address - Street 1:810 S DURANGO DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-2423
Practice Address - Country:US
Practice Address - Phone:702-240-0874
Practice Address - Fax:702-240-3627
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV9535207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVH62150Medicare UPIN