Provider Demographics
NPI:1639255920
Name:MARINO-VILLAMIZAR, CATALINA (MD)
Entity Type:Individual
Prefix:
First Name:CATALINA
Middle Name:
Last Name:MARINO-VILLAMIZAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 E 149TH ST RM 420
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-5504
Mailing Address - Country:US
Mailing Address - Phone:718-579-5800
Mailing Address - Fax:718-579-4700
Practice Address - Street 1:234 E 149TH ST RM 420
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5504
Practice Address - Country:US
Practice Address - Phone:718-579-5365
Practice Address - Fax:718-579-4700
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA08127500208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0112674Medicaid