MEDICARE: RAUL ANGEL MARIN

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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1558206862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAUL ANGEL MARIN

Provider Business Mailing Address
First Line	:	6343 1/2 PROSPECT AVE
Second Line	:
City	:	BELL
State	:	CA
Zip	:	90201-1395
Country	:	US
Telephone Number	:	323-525-6400
Fax Number	:	323-983-9309

Provider Business Practice Location Address
First Line	:	8300 S VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90044-3493
Country	:	US
Telephone Number	:	323-525-6400
Fax Number	:	323-983-9309

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

Provider Enumeration Date	:	04/22/2026
Last Update Date	:	04/22/2026

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