Healthcare Provider Details

I. General information

NPI: 1922165539
Provider Name (Legal Business Name): ROSA MARIA MARIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 SE 4TH ST
BOYNTON BEACH FL
33435-4905
US

IV. Provider business mailing address

115 SE 4TH ST
BOYNTON BEACH FL
33435-4905
US

V. Phone/Fax

Practice location:
  • Phone: 561-732-2701
  • Fax: 561-732-0354
Mailing address:
  • Phone: 561-732-2701
  • Fax: 561-732-0354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME74617
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME0074617
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: