Healthcare Provider Details

I. General information

NPI: 1447306196
Provider Name (Legal Business Name): DR. PAULETTE MARIA MARIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAULETTE M MCLARNEY

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1494 ST FRANCIS DR
SANTA FE NM
87505
US

IV. Provider business mailing address

19 COYOTE SPRINGS RD
SANTA FE NM
87508
US

V. Phone/Fax

Practice location:
  • Phone: 505-699-4482
  • Fax: 505-983-5017
Mailing address:
  • Phone: 505-473-2933
  • Fax: 505-983-5017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number68
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number788
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: