Provider Demographics
NPI:1568907467
Name:MARIN GUILLENT, LUIS RAFAEL (SA-C)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:RAFAEL
Last Name:MARIN GUILLENT
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8901 SW 142ND AVE APT 6-11
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-1201
Mailing Address - Country:US
Mailing Address - Phone:386-444-9797
Mailing Address - Fax:
Practice Address - Street 1:8901 SW 142ND AVE APT 6-11
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1201
Practice Address - Country:US
Practice Address - Phone:386-444-9797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-30
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16-596246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant