Healthcare Provider Details

I. General information

NPI: 1356358311
Provider Name (Legal Business Name): JONATHAN L. MARINARO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ANESTHESIOLOGY & CRITICAL CARE MEDICINE UNMH - 2211 LOMAS BLVD. NE
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

5605 N MACARTHUR BLVD STE 740
IRVING TX
75038-2626
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2610
  • Fax:
Mailing address:
  • Phone: 214-960-5681
  • Fax: 214-960-5681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberW1457
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2002-0149
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberW1457
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD2002-0149
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License NumberW1457
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: