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NPI Code Detail

MEDICARE: MRS. LUCIANNE MARIN M.D.

MEDICARE: MRS. LUCIANNE MARIN M.D.
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
1208000000XPediatrics PhysicianP8503TX

General Provider Information

NPI Number : 1821024654
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LUCIANNE MARIN M.D.
Provider Business Mailing Address
First Line : 6510 ROCHESTER WAY
Second Line :
City : TYLER
State : TX
Zip : 75703-4241
Country : US
Telephone Number : 703-599-3164
Fax Number :
Provider Business Practice Location Address
First Line : 214 E HOUSTON ST
Second Line :
City : TYLER
State : TX
Zip : 75702-8131
Country : US
Telephone Number : 903-535-9041
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2006
Last Update Date : 11/21/2024

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Directions to “ MRS. LUCIANNE MARIN M.D.” Practice Location

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