Provider Demographics
NPI:1629726658
Name:DINNALL, MARLENE PENNYLOPE
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:PENNYLOPE
Last Name:DINNALL
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 1:18800 NW 2ND AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-4064
Mailing Address - Country:US
Mailing Address - Phone:305-653-4755
Mailing Address - Fax:305-653-8520
Practice Address - Street 1:18800 NW 2ND AVE STE 120
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-4064
Practice Address - Country:US
Practice Address - Phone:305-653-4755
Practice Address - Fax:305-653-8520
Is Sole Proprietor?:No
Enumeration Date:2022-03-18
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor