MEDICARE: AUGUSTO C MARIN MD PC

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	207V00000X	Obstetrics & Gynecology Physician	10292	AZ

General Provider Information

NPI Number	:	1700260064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUGUSTO C MARIN MD PC

Provider Business Mailing Address
First Line	:	809 E WASHINGTON ST
Second Line	:	STE. 201
City	:	PHOENIX
State	:	AZ
Zip	:	85034-1052
Country	:	US
Telephone Number	:	602-254-9695
Fax Number	:	602-254-8120

Provider Business Practice Location Address
First Line	:	809 E WASHINGTON ST
Second Line	:	STE. 201
City	:	PHOENIX
State	:	AZ
Zip	:	85034-1052
Country	:	US
Telephone Number	:	602-254-9695
Fax Number	:	602-254-8120

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	DR. AUGUSTO CASTRO CASTRO-MARIN
Credential	:	M.D.
Telephone Number	:	602-254-9695

Provider Enumeration Date	:	07/16/2015
Last Update Date	:	07/16/2015

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