MEDICARE: MARNEL THELUSMA

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1619415536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARNEL THELUSMA

Provider Business Mailing Address
First Line	:	PO BOX 268175
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33326-8175
Country	:	US
Telephone Number	:	954-226-2812
Fax Number	:

Provider Business Practice Location Address
First Line	:	18690 NW 2ND AVE
Second Line	:	100
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33169-4508
Country	:	US
Telephone Number	:	754-423-9194
Fax Number	:

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

Provider Enumeration Date	:	02/11/2017
Last Update Date	:	02/11/2017

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Directions to “ MARNEL THELUSMA ” Practice Location

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