Provider Demographics
NPI:1740359900
Name:MARIN, OFELIA ELISA (MD)
Entity type:Individual
Prefix:
First Name:OFELIA
Middle Name:ELISA
Last Name:MARIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5955 PONCE DE LEON BLVD
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2423
Mailing Address - Country:US
Mailing Address - Phone:305-661-1515
Mailing Address - Fax:305-662-3723
Practice Address - Street 1:2600 IMMOKALEE RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1424
Practice Address - Country:US
Practice Address - Phone:239-213-0690
Practice Address - Fax:239-552-4060
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2014-08-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MT112142080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A52452AMedicaid
CAE88100Medicare UPIN
CAA52452AMedicare ID - Type Unspecified