Healthcare Provider Details

I. General information

NPI: 1740359900
Provider Name (Legal Business Name): OFELIA ELISA MARIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 08/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 IMMOKALEE RD
NAPLES FL
34110-1424
US

IV. Provider business mailing address

5955 PONCE DE LEON BLVD
CORAL GABLES FL
33146-2423
US

V. Phone/Fax

Practice location:
  • Phone: 239-213-0690
  • Fax: 239-552-4060
Mailing address:
  • Phone: 305-661-1515
  • Fax: 305-662-3723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number11214
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: