Healthcare Provider Details

I. General information

NPI: 1336889070
Provider Name (Legal Business Name): EDUARDO MIGUEL MARINO URBINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 NW 102ND WAY
PEMBROKE PINES FL
33026-1829
US

IV. Provider business mailing address

2421 NW 102ND WAY
PEMBROKE PINES FL
33026-1829
US

V. Phone/Fax

Practice location:
  • Phone: 786-792-1001
  • Fax:
Mailing address:
  • Phone: 786-792-1001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME170190
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberV3906
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: