Individual
EDWARD L MARINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
1801 16TH ST, GREELEY, CO 80631-5154
(970) 378-4433
Mailing address
1801 16TH ST, GREELEY, CO 80631-5154
(970) 378-4433
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1222
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
63524503
—
CO
Enumeration date
07/03/2006
Last updated
04/28/2011
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