Healthcare Provider Details

I. General information

NPI: 1699170175
Provider Name (Legal Business Name): LUISA JULYNETTE EDWARDS MARZAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2014
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4105 PEMBROKE RD
HOLLYWOOD FL
33021-8103
US

IV. Provider business mailing address

2900 CORPORATE WAY DOOR D
MIRAMAR FL
33025-3925
US

V. Phone/Fax

Practice location:
  • Phone: 954-276-5552
  • Fax: 954-985-2295
Mailing address:
  • Phone: 954-276-5980
  • Fax: 954-985-7074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME131909
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: