Basic Information
| Provider Information | |||||||||
| NPI: | 1053666719 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARIN | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | ALBERTO | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4849 N MESA ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799125919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9153516600 | ||||||||
| FaxNumber: | 9153516601 | ||||||||
| Practice Location | |||||||||
| Address1: | 13001 EASTLAKE BLVD STE 105-106 | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799286311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9152482345 | ||||||||
| FaxNumber: | 9152714412 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2012 | ||||||||
| LastUpdateDate: | 09/25/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD2014-0967 | NM | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 28872 | PR | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | Q3405 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.