Provider Demographics
NPI:1679696983
Name:MARINEZ, JAVIER EMILIO (MD)
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:EMILIO
Last Name:MARINEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAVIER
Other - Middle Name:EMILIO
Other - Last Name:MARINEZ REGUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:685 PALM SPRINGS DR
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-7853
Mailing Address - Country:US
Mailing Address - Phone:407-830-5577
Mailing Address - Fax:407-830-4164
Practice Address - Street 1:685 PALM SPRINGS DR
Practice Address - Street 2:SUITE 2A
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-7853
Practice Address - Country:US
Practice Address - Phone:407-830-5577
Practice Address - Fax:407-830-4164
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96871207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004262500Medicaid
FLFF941ZMedicare PIN