Provider Demographics
NPI:1952068157
Name:HOSPITAL MARINA MAZATLAN
Entity type:Organization
Organization Name:HOSPITAL MARINA MAZATLAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAZUETA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:669-114-3741
Mailing Address - Street 1:AV CARLOS CANSECO 6048 LA MARINA
Mailing Address - Street 2:
Mailing Address - City:MAZATLAN
Mailing Address - State:SINALOA
Mailing Address - Zip Code:82103
Mailing Address - Country:MX
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AV CARLOS CANSECO 06048/00000
Practice Address - Street 2:MARINA MAZATLAN
Practice Address - City:MAZATLAN
Practice Address - State:SINALOA
Practice Address - Zip Code:82103
Practice Address - Country:MX
Practice Address - Phone:669-913-1000
Practice Address - Fax:862-345-2766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-22
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3728110Other3728110
37282110OtherOTHER