Provider Demographics
NPI:1811197114
Name:MARINA LAKES MEDICAL CENTER CORP
Entity Type:Organization
Organization Name:MARINA LAKES MEDICAL CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-277-5669
Mailing Address - Street 1:4960 SW 72ND AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-5544
Mailing Address - Country:US
Mailing Address - Phone:305-740-9889
Mailing Address - Fax:
Practice Address - Street 1:4960 SW 72ND AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-5544
Practice Address - Country:US
Practice Address - Phone:305-740-9889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7752261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation