Basic Information
| Provider Information | |||||||||
| NPI: | 1629681820 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JAIME MARIN | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | SUSANA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RBT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7348 SW 82ND ST APT C218 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331437430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052820013 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10250 SW 56 ST | ||||||||
| Address2: | D201 | ||||||||
| City: | MIAMI | ||||||||
| State: | FLORIDA | ||||||||
| PostalCode: | 33165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8885278037 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2020 | ||||||||
| LastUpdateDate: | 10/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | RBT-20-131816 | FL | Y |
No ID Information.