Healthcare Provider Details

I. General information

NPI: 1093730384
Provider Name (Legal Business Name): TOMAS I MARIMON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11760 SW 40TH ST SUITE #518
MIAMI FL
33175-3582
US

IV. Provider business mailing address

11760 SW 40TH ST SUITE #518
MIAMI FL
33175-3582
US

V. Phone/Fax

Practice location:
  • Phone: 305-553-2888
  • Fax: 305-553-0291
Mailing address:
  • Phone: 305-553-2888
  • Fax: 305-553-0291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME41457
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: