Provider Demographics
NPI:1558730770
Name:MARLIN, LESTER ANTONIO
Entity Type:Individual
Prefix:MR
First Name:LESTER
Middle Name:ANTONIO
Last Name:MARLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20325 SHERMAN WAY
Mailing Address - Street 2:APT.44
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-3161
Mailing Address - Country:US
Mailing Address - Phone:313-463-9121
Mailing Address - Fax:
Practice Address - Street 1:20325 SHERMAN WAY
Practice Address - Street 2:APT44
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306
Practice Address - Country:US
Practice Address - Phone:313-463-9121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No175T00000XOther Service ProvidersPeer Specialist