Provider Demographics
NPI:1427739879
Name:MARIN, MATHEW JELANI (SRNA)
Entity type:Individual
Prefix:
First Name:MATHEW
Middle Name:JELANI
Last Name:MARIN
Suffix:
Gender:M
Credentials:SRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VILLAS DE CAMBALACHE 1
Mailing Address - Street 2:N2 CALLE CAOBA BZN. 125
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745
Mailing Address - Country:US
Mailing Address - Phone:787-403-5415
Mailing Address - Fax:
Practice Address - Street 1:ESCUELA DE ENFERMERIA - RCM
Practice Address - Street 2:P. DR. JOSE CELSO BARBOSA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-758-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-28
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR19557300163W00000X
PR98365-G163W00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No163W00000XNursing Service ProvidersRegistered Nurse