Provider Demographics
NPI:1558766782
Name:MARINI, MARIO (LIC ACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:MARINI
Suffix:
Gender:M
Credentials:LIC ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 AVENTURA BLVD
Mailing Address - Street 2:CHEN MEDICAL AVENTURA INC
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3118
Mailing Address - Country:US
Mailing Address - Phone:305-466-7333
Mailing Address - Fax:305-466-7364
Practice Address - Street 1:2845 AVENTURA BLVD
Practice Address - Street 2:CHEN MEDICAL AVENTURA INC
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3118
Practice Address - Country:US
Practice Address - Phone:305-466-7333
Practice Address - Fax:305-466-7364
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-30
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3520171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist