Provider Demographics
NPI:1922165539
Name:MARIN, ROSA MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSA
Middle Name:MARIA
Last Name:MARIN
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 1:115 SE 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-4905
Mailing Address - Country:US
Mailing Address - Phone:561-732-2701
Mailing Address - Fax:561-732-0354
Practice Address - Street 1:115 SE 4TH ST
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-4905
Practice Address - Country:US
Practice Address - Phone:561-732-2701
Practice Address - Fax:561-732-0354
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74617207R00000X
FLME0074617207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG54629Medicare UPIN
44699XMedicare ID - Type Unspecified