Basic Information
| Provider Information | |||||||||
| NPI: | 1164763215 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PERMIAKOVA | ||||||||
| FirstName: | MARINA | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14416 W MEEKER BLVD BLDG C | ||||||||
| Address2: | STE 200 | ||||||||
| City: | SUN CITY WEST | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853755284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235835271 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 14416 W MEEKER BLVD BLDG C | ||||||||
| Address2: | STE 200 | ||||||||
| City: | SUN CITY WEST | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853755284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235835271 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2013 | ||||||||
| LastUpdateDate: | 02/04/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | BP10042480 | TX | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.