MEDICARE: DR. LUIS A MARINI DMD

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	1223P0221X	Pediatric Dentistry	802	PR

General Provider Information

NPI Number	:	1659562478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUIS A MARINI DMD

Provider Business Mailing Address
First Line	:	CALLE CESAR GONZALEZ # 612
Second Line	:	APT. 1602
City	:	SAN JUAN
State	:	PR
Zip	:	00918-3901
Country	:	US
Telephone Number	:	787-553-9303
Fax Number	:

Provider Business Practice Location Address
First Line	:	654 AVE MUNOZ RIVERA
Second Line	:	SUITE 1111
City	:	SAN JUAN
State	:	PR
Zip	:	00918-4123
Country	:	US
Telephone Number	:	787-553-9303
Fax Number	:

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

Provider Enumeration Date	:	08/06/2007
Last Update Date	:	08/06/2007

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