Provider Demographics
NPI:1568265296
Name:MARMOL, EDUARDO R
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:R
Last Name:MARMOL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13139 CENTRAL AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-3031
Mailing Address - Country:US
Mailing Address - Phone:510-861-0772
Mailing Address - Fax:
Practice Address - Street 1:13139 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123-3031
Practice Address - Country:US
Practice Address - Phone:510-861-0772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator