=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922165539
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROSA MARIA MARIN M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/02/2007
-----------------------------------------------------
Last Update Date | 07/14/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 115 SE 4TH ST
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33435-4905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-732-2701
-----------------------------------------------------
Fax | 561-732-0354
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 115 SE 4TH ST
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33435-4905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-732-2701
-----------------------------------------------------
Fax | 561-732-0354
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME74617
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME0074617
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------