Provider Demographics
NPI:1508455445
Name:MARINES, IRENE
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:MARINES
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 1:544 QUAIL CIR
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-4022
Mailing Address - Country:US
Mailing Address - Phone:409-457-8581
Mailing Address - Fax:
Practice Address - Street 1:544 QUAIL CIR
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-4022
Practice Address - Country:US
Practice Address - Phone:409-457-8581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator