Provider Demographics
NPI:1518770510
Name:LEGORRETA, MARINA
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:LEGORRETA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 N HENDERSON AVE STE 1215
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-7387
Mailing Address - Country:US
Mailing Address - Phone:214-779-3531
Mailing Address - Fax:
Practice Address - Street 1:2310 N HENDERSON AVE STE 1215
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-7387
Practice Address - Country:US
Practice Address - Phone:214-779-3531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-31
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Q00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyGroup - Single Specialty