Provider Demographics
NPI:1497986798
Name:ANTUNEZ, MARINA
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:ANTUNEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 E RILEY DR
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-2154
Mailing Address - Country:US
Mailing Address - Phone:623-932-7300
Mailing Address - Fax:623-932-0650
Practice Address - Street 1:530 E RILEY DR
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-2154
Practice Address - Country:US
Practice Address - Phone:623-932-7300
Practice Address - Fax:623-932-0650
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP045315164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse