Provider Demographics
NPI:1912147000
Name:MARIN, GUILLERMO MANUEL I (SURGICAL ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:GUILLERMO
Middle Name:MANUEL
Last Name:MARIN
Suffix:I
Gender:M
Credentials:SURGICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3526 CANAL RD
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-3533
Mailing Address - Country:US
Mailing Address - Phone:561-541-9097
Mailing Address - Fax:561-966-5436
Practice Address - Street 1:3526 CANAL RD
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-3533
Practice Address - Country:US
Practice Address - Phone:561-541-9097
Practice Address - Fax:561-966-5436
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL09109246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00000000Other000000000