Provider Demographics
NPI:1669121539
Name:ROFAEIL, MARINA
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:ROFAEIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6913 DREAM DUST DR
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-5119
Mailing Address - Country:US
Mailing Address - Phone:817-899-7630
Mailing Address - Fax:
Practice Address - Street 1:6913 DREAM DUST DR
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-5119
Practice Address - Country:US
Practice Address - Phone:817-899-7630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-19
Last Update Date:2022-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty