Healthcare Provider Details

I. General information

NPI: 1225484892
Provider Name (Legal Business Name): DIEGO ALBERTO MARIN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2016
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 CLINT MOORE RD STE 100
BOCA RATON FL
33487-5712
US

IV. Provider business mailing address

1601 CLINT MOORE RD STE 100
BOCA RATON FL
33487-5712
US

V. Phone/Fax

Practice location:
  • Phone: 561-939-0200
  • Fax:
Mailing address:
  • Phone: 561-939-0200
  • Fax: 561-939-0274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberOS19144
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberOS19144
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: