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General NPI Number Information
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NPI Number | 1720642291
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Entity Type | Individual
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Provider Name | DIANA MARIN
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Gender | Female
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Dates
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Enumeration Date | 04/30/2019
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Last Update Date | 08/19/2021
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Provider Practice Location Address
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Address Line | 5590 W 20TH AVE STE 400-401
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City | HIALEAH
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State | FL
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Zip | 33016-7070
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Country | US
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Telephone | 305-825-4320
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Fax | 305-825-8117
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Provider Business Mailing Address
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Address Line | 9460 FONTAINEBLEAU BLVD APT 220
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City | MIAMI
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State | FL
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Zip | 33172-7522
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Country | US
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Telephone | 786-218-8780
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | FL
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