Healthcare Provider Details

I. General information

NPI: 1568150233
Provider Name (Legal Business Name): MANUEL JOSE MARIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5817 PATTON ST STE 101
CORPUS CHRISTI TX
78414-2428
US

IV. Provider business mailing address

5817 PATTON ST STE 101
CORPUS CHRISTI TX
78414-2428
US

V. Phone/Fax

Practice location:
  • Phone: 361-992-9383
  • Fax:
Mailing address:
  • Phone: 361-992-9383
  • Fax: 361-992-9543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberW7364
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: