Provider Demographics
NPI:1144636846
Name:MARINO-NIETO, JIMENA (MD)
Entity type:Individual
Prefix:
First Name:JIMENA
Middle Name:
Last Name:MARINO-NIETO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JIMENA
Other - Middle Name:
Other - Last Name:MARINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1611 NW 12TH AVE # C-301
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1005
Mailing Address - Country:US
Mailing Address - Phone:305-585-6970
Mailing Address - Fax:305-545-6501
Practice Address - Street 1:21C COND SANTA ANA
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966
Practice Address - Country:US
Practice Address - Phone:787-480-2791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME136422207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology