Basic Information
Provider Information
NPI: 1992474670
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MARIN
FirstName: VALERIA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: DNP, APRN FNP-BC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 14100 SAN PEDRO AVE STE 412
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782322009
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 8403 SH 151 STE 108
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782452055
CountryCode: US
TelephoneNumber: 2109984790
FaxNumber: 2103145044
Other Information
ProviderEnumerationDate: 09/07/2021
LastUpdateDate: 09/07/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/07/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X1032749TXY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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