MEDICARE: LEONARDO MARIN CCP

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	242T00000X	Perfusionist	FPF00001214	TX

General Provider Information

NPI Number	:	1972437085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONARDO MARIN CCP

Provider Business Mailing Address
First Line	:	7448 CIMARRON RIM DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79911-4004
Country	:	US
Telephone Number	:	915-314-3625
Fax Number	:

Provider Business Practice Location Address
First Line	:	1625 MEDICAL CENTER DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902-5005
Country	:	US
Telephone Number	:	915-314-3625
Fax Number	:

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

Provider Enumeration Date	:	06/12/2026
Last Update Date	:	06/12/2026

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Directions to “ LEONARDO MARIN CCP” Practice Location

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