Healthcare Provider Details

I. General information

NPI: 1902919475
Provider Name (Legal Business Name): ELENA MARIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 TREASURE HILLS BLVD
HARLINGEN TX
78550-8911
US

IV. Provider business mailing address

1706 TREASURE HILLS BLVD
HARLINGEN TX
78550-8911
US

V. Phone/Fax

Practice location:
  • Phone: 956-365-6750
  • Fax: 956-365-6779
Mailing address:
  • Phone: 956-365-6750
  • Fax: 956-365-6779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG9923
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: