Provider Demographics
NPI:1568757854
Name:MARIANA NATURAL HEALTH CO
Entity Type:Organization
Organization Name:MARIANA NATURAL HEALTH CO
Other - Org Name:NATURALHEALTH CHOICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIANA
Authorized Official - Middle Name:PAVLOVA
Authorized Official - Last Name:KAMBUROV
Authorized Official - Suffix:
Authorized Official - Credentials:DOM, AP
Authorized Official - Phone:352-378-8002
Mailing Address - Street 1:2245 NW 40TH PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-1755
Mailing Address - Country:US
Mailing Address - Phone:954-439-8729
Mailing Address - Fax:352-378-8002
Practice Address - Street 1:1209 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-4113
Practice Address - Country:US
Practice Address - Phone:352-378-8002
Practice Address - Fax:352-378-8002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-14
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2980171100000X, 261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1972784122OtherNPPES
FL1568757854OtherNPPES