Provider Demographics
NPI:1609023662
Name:MARINA, ELENA
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:MARINA
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:COND TERRA AZUL
Mailing Address - Street 2:18
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-7201
Mailing Address - Country:US
Mailing Address - Phone:787-690-8316
Mailing Address - Fax:
Practice Address - Street 1:COND TERRA AZUL
Practice Address - Street 2:18
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-7201
Practice Address - Country:US
Practice Address - Phone:787-690-8316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13068172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker