Provider Demographics
NPI:1255125084
Name:BANOUB, MARINA (PA)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:BANOUB
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Gender:
Credentials:PA
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Mailing Address - Street 1:8144 WALNUT HILL LN STE 800
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4345
Mailing Address - Country:US
Mailing Address - Phone:214-540-0700
Mailing Address - Fax:214-540-0700
Practice Address - Street 1:8221 MID CITIES BLVD STE 200
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76182-4726
Practice Address - Country:US
Practice Address - Phone:214-540-0700
Practice Address - Fax:214-540-0701
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant