Provider Demographics
NPI:1316941107
Name:MARIN, LUISA (MD)
Entity type:Individual
Prefix:
First Name:LUISA
Middle Name:
Last Name:MARIN
Suffix:
Gender:F
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:PO BOX 5865
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79408-5865
Mailing Address - Country:US
Mailing Address - Phone:806-743-3150
Mailing Address - Fax:806-743-3168
Practice Address - Street 1:3601 4TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-9410
Practice Address - Country:US
Practice Address - Phone:806-743-3150
Practice Address - Fax:806-743-3168
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0481207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171102001Medicaid
TX171102003Medicaid
8D0979Medicare ID - Type Unspecified
I24292Medicare UPIN
TX171102003Medicaid