Healthcare Provider Details

I. General information

NPI: 1558266601
Provider Name (Legal Business Name): MARIN PEDIATRIC GASTROENTEROLOGY AND NUTRITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10661 AIRPORT-PULLING RD SUITE 9
NAPLES FL
34109
US

IV. Provider business mailing address

10661 AIRPORT PULLING RD SUITE # 9
NAPLES FL
34109
US

V. Phone/Fax

Practice location:
  • Phone: 239-591-8481
  • Fax: 239-596-0212
Mailing address:
  • Phone: 239-591-8481
  • Fax: 239-596-0212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: OFELIA MARIN MARIN
Title or Position: MD
Credential:
Phone: 239-224-8866