Healthcare Provider Details

I. General information

NPI: 1366531667
Provider Name (Legal Business Name): MARINA PLON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4275 BURNHAM AVE SUITE 220
LAS VEGAS NV
89119-5488
US

IV. Provider business mailing address

4275 BURNHAM AVE SUITE 220
LAS VEGAS NV
89119-5488
US

V. Phone/Fax

Practice location:
  • Phone: 702-734-0808
  • Fax: 702-734-2650
Mailing address:
  • Phone: 702-734-0808
  • Fax: 702-734-2650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number5191
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: