Provider Demographics
NPI:1467230441
Name:MARROD HEALTHCARE PROVIDER, LLC.
Entity Type:Organization
Organization Name:MARROD HEALTHCARE PROVIDER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:MARTINEZ PENTON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:832-407-6082
Mailing Address - Street 1:25914 SUNDROP MEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-3171
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5330 FRY RD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-6920
Practice Address - Country:US
Practice Address - Phone:832-810-5060
Practice Address - Fax:832-810-5080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care