Healthcare Provider Details

I. General information

NPI: 1104754365
Provider Name (Legal Business Name): MIGUEL MARIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CALLE CASIA
SAN JUAN PR
00921-3201
US

IV. Provider business mailing address

1485-2 AVE ASHFORD APT 702
SAN JUAN PR
00907-6503
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-7582
  • Fax:
Mailing address:
  • Phone: 787-320-8281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number7129623
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: