Provider Demographics
NPI:1669622130
Name:ANGEL B MARIN MD PA
Entity type:Organization
Organization Name:ANGEL B MARIN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:MARIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:305-822-3019
Mailing Address - Street 1:PO BOX 22635
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33002-2634
Mailing Address - Country:US
Mailing Address - Phone:305-822-3019
Mailing Address - Fax:305-822-3048
Practice Address - Street 1:6195 W 8TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-6537
Practice Address - Country:US
Practice Address - Phone:305-822-3019
Practice Address - Fax:305-822-3048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-22
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME21831208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D59980Medicare UPIN