Provider Demographics
NPI:1396411005
Name:HOSPITAL MARINA MAZATLAN
Entity Type:Organization
Organization Name:HOSPITAL MARINA MAZATLAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATIAS
Authorized Official - Middle Name:EDUARDO
Authorized Official - Last Name:ZAZUETA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:331-071-5051
Mailing Address - Street 1:AV. CARLOS CANSECO 6048, LA MARINA
Mailing Address - Street 2:
Mailing Address - City:MAZATLAN
Mailing Address - State:SIN
Mailing Address - Zip Code:82103
Mailing Address - Country:MX
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AV. CARLOS CANSECO 6048, LA MARINA
Practice Address - Street 2:COLONIA ALTA VISTA
Practice Address - City:MAZATLAN
Practice Address - State:SIN
Practice Address - Zip Code:82103
Practice Address - Country:MX
Practice Address - Phone:331-071-5051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-22
Last Update Date:2021-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6359DGP1516408OtherOTHER