Provider Demographics
NPI:1306600572
Name:MARIN MARTINEZ, FABIAN
Entity type:Individual
Prefix:
First Name:FABIAN
Middle Name:
Last Name:MARIN MARTINEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 7 BOX 32146
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-9205
Mailing Address - Country:US
Mailing Address - Phone:787-718-3321
Mailing Address - Fax:
Practice Address - Street 1:ESTANCIAS DEL SUR CALLE GUASIMA I23
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-9205
Practice Address - Country:US
Practice Address - Phone:787-718-3321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3011390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program