Provider Demographics
NPI:1346099827
Name:MARIN, MANUEL ANTONIO
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:ANTONIO
Last Name:MARIN
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 1:7123 THICKET BRANCH ALY
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-0208
Mailing Address - Country:US
Mailing Address - Phone:321-438-5710
Mailing Address - Fax:
Practice Address - Street 1:7123 THICKET BRANCH ALY
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-0208
Practice Address - Country:US
Practice Address - Phone:321-438-5710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-16
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No251C00000XAgenciesDay Training, Developmentally Disabled Services