Provider Demographics
NPI:1063773539
Name:GUIMERA-REVELO, MARIENY E (MD)
Entity type:Individual
Prefix:DR
First Name:MARIENY
Middle Name:E
Last Name:GUIMERA-REVELO
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18459 PINES BLVD STE 213
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-1400
Mailing Address - Country:US
Mailing Address - Phone:954-990-0595
Mailing Address - Fax:954-990-0596
Practice Address - Street 1:680 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6738
Practice Address - Country:US
Practice Address - Phone:954-981-2555
Practice Address - Fax:954-990-0596
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME124324207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0015658200Medicaid