Provider Demographics
NPI:1285736363
Name:INIGO, MARISA CELIA (MD)
Entity type:Individual
Prefix:DR
First Name:MARISA
Middle Name:CELIA
Last Name:INIGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:MARISA
Other - Middle Name:CELIA
Other - Last Name:INIGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:521 S 12TH ST
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539
Mailing Address - Country:US
Mailing Address - Phone:956-380-1491
Mailing Address - Fax:956-380-1494
Practice Address - Street 1:521 S 12TH ST
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539
Practice Address - Country:US
Practice Address - Phone:956-380-1491
Practice Address - Fax:956-380-1494
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9525207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E99367Medicare UPIN
TXOOJ97EMedicare ID - Type Unspecified