Provider Demographics
NPI:1437144276
Name:MARINA, OTILIA A (MD)
Entity Type:Individual
Prefix:MS
First Name:OTILIA
Middle Name:A
Last Name:MARINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:203 N PARK AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-4101
Mailing Address - Country:US
Mailing Address - Phone:407-886-4344
Mailing Address - Fax:407-886-4425
Practice Address - Street 1:203 N PARK AVE
Practice Address - Street 2:STE 105
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-4101
Practice Address - Country:US
Practice Address - Phone:407-886-4344
Practice Address - Fax:407-886-4425
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43650207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D55181Medicare UPIN
47795Medicare ID - Type Unspecified