=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396776746
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAIRO J MARIN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1140 W. LA VETA AVE. SUITE # 640
-----------------------------------------------------
City | ORANGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92868-4228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-564-3300
-----------------------------------------------------
Fax | 714-564-3318
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1140 W. LA VETA AVE. SUITE # 640
-----------------------------------------------------
City | ORANGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92868-4228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-564-3300
-----------------------------------------------------
Fax | 714-564-3318
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | G49117
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RI0011X
-----------------------------------------------------
Taxonomy Name | Interventional Cardiology Physician
-----------------------------------------------------
License Number | G49117
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------