Provider Demographics
NPI:1376838813
Name:MARINO, JULIO JORGE
Entity Type:Individual
Prefix:
First Name:JULIO
Middle Name:JORGE
Last Name:MARINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9290 HAMMOCKS BLVD
Mailing Address - Street 2:SUITE 405
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-1508
Mailing Address - Country:US
Mailing Address - Phone:305-382-1009
Mailing Address - Fax:305-382-1009
Practice Address - Street 1:9290 HAMMOCKS BLVD
Practice Address - Street 2:SUITE 405
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1508
Practice Address - Country:US
Practice Address - Phone:305-382-1009
Practice Address - Fax:305-382-1009
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA44754208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty