Provider Demographics
NPI:1679000566
Name:MARRON DEL PINO, JOSE CARLOS (SA-C)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:CARLOS
Last Name:MARRON DEL PINO
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 1:14851 SW 158TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33187-0608
Mailing Address - Country:US
Mailing Address - Phone:786-856-2951
Mailing Address - Fax:
Practice Address - Street 1:14851 SW 158TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33187-0608
Practice Address - Country:US
Practice Address - Phone:786-856-2951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-22
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17-308246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant