Basic Information
Provider Information
NPI: 1245343813
EntityType: 2
ReplacementNPI:  
OrganizationName: HRISTO DIMITROV MARINOV MD PC
LastName:  
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Credential:  
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Mailing Information
Address1: PO BOX 13385
Address2:  
City: SCOTTSDALE
State: AZ
PostalCode: 852673385
CountryCode: US
TelephoneNumber: 4806099300
FaxNumber: 4806099350
Practice Location
Address1: 2000 W BETHANY HOME RD
Address2:  
City: PHOENIX
State: AZ
PostalCode: 85015
CountryCode: US
TelephoneNumber: 4806099300
FaxNumber: 4806099350
Other Information
ProviderEnumerationDate: 08/16/2006
LastUpdateDate: 10/17/2007
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: MARINOV
AuthorizedOfficialFirstName: HRISTO
AuthorizedOfficialMiddleName: D
AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 4806099300
IsSoleProprietor:  
IsOrganizationSubpart: N
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AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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