Healthcare Provider Details

I. General information

NPI: 1144636846
Provider Name (Legal Business Name): JIMENA MARINO-NIETO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JIMENA MARINO MD

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 05/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21C COND SANTA ANA
GUAYNABO PR
00966
US

IV. Provider business mailing address

1611 NW 12TH AVE # C-301
MIAMI FL
33136-1005
US

V. Phone/Fax

Practice location:
  • Phone: 787-480-2791
  • Fax:
Mailing address:
  • Phone: 305-585-6970
  • Fax: 305-545-6501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME136422
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: