Healthcare Provider Details

I. General information

NPI: 1962190827
Provider Name (Legal Business Name): MAURA LUCY ABRAHAM MARIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2023
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21342 W DIXIE HWY
MIAMI FL
33180-1134
US

IV. Provider business mailing address

671 NE 193RD ST
MIAMI FL
33179-3977
US

V. Phone/Fax

Practice location:
  • Phone: 754-707-1330
  • Fax:
Mailing address:
  • Phone: 754-707-1330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberME178473
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: