MEDICARE: MARINA AESTHETIC INSTITUTE PLLC

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	208200000X	Plastic Surgery Physician

General Provider Information

NPI Number	:	1144166588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARINA AESTHETIC INSTITUTE PLLC

Provider Business Mailing Address
First Line	:	1700 MURCHISON DR STE 215
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902-2918
Country	:	US
Telephone Number	:	352-246-5681
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 MURCHISON DR STE 215
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902-2918
Country	:	US
Telephone Number	:	352-246-5681
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGING MEMBER
Name	:	SHAY DEAN
Credential	:	MD
Telephone Number	:	352-246-5681

Provider Enumeration Date	:	04/27/2026
Last Update Date	:	04/27/2026

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