Provider Demographics
NPI:1720469679
Name:TANYA V MARIN, PC
Entity Type:Organization
Organization Name:TANYA V MARIN, PC
Other - Org Name:SANTA TERESA CHILDREN'S NIGHT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PEDIATRIC NURSE PRACTITIONER/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:VERONICA
Authorized Official - Last Name:MARIN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, CPNP-PC
Authorized Official - Phone:575-332-4633
Mailing Address - Street 1:1245 COUNTRY CLUB RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SANTA TERESA
Mailing Address - State:NM
Mailing Address - Zip Code:88008-9743
Mailing Address - Country:US
Mailing Address - Phone:575-332-4633
Mailing Address - Fax:575-332-4635
Practice Address - Street 1:1245 COUNTRY CLUB RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SANTA TERESA
Practice Address - State:NM
Practice Address - Zip Code:88008-9743
Practice Address - Country:US
Practice Address - Phone:575-332-4633
Practice Address - Fax:575-332-4635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care