MEDICARE: CESAR MARIN INTERN MENTAL HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1245748995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CESAR MARIN INTERN MENTAL HEALTH

Provider Business Mailing Address
First Line	:	2901 W SAINT ISABEL ST STE A1
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6350
Country	:	US
Telephone Number	:	888-666-3089
Fax Number	:

Provider Business Practice Location Address
First Line	:	2901 W SAINT ISABEL ST STE A1
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6350
Country	:	US
Telephone Number	:	888-666-3089
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2018
Last Update Date	:	01/16/2018

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