Healthcare Provider Details

I. General information

NPI: 1285423434
Provider Name (Legal Business Name): CARLOS ALBERTO MARIN LOPEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 RAINBOW BLVD MAILSTOP 1022
KANSAS CITY KS
66160
US

IV. Provider business mailing address

3901 RAINBOW BLVD MAILSTOP 1022
KANSAS CITY KS
66160
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-6000
  • Fax: 913-588-3995
Mailing address:
  • Phone: 913-588-6000
  • Fax: 913-588-3995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: