MEDICARE: DR. LUIS ENRIQUE MARIN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	U6011	TX
2	208M00000X	Hospitalist Physician	U6011	TX

General Provider Information

NPI Number	:	1063038990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUIS ENRIQUE MARIN MD

Provider Business Mailing Address
First Line	:	320 VIN RALIUGA CT
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-2392
Country	:	US
Telephone Number	:	915-400-5871
Fax Number	:	915-856-2458

Provider Business Practice Location Address
First Line	:	320 VIN RALIUGA CT
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-2392
Country	:	US
Telephone Number	:	915-400-5871
Fax Number	:	915-856-2458

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2020
Last Update Date	:	06/25/2024

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