Individual
DR. DOMENIC MARINI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
19 OLD KINGS RD N, SUITE C-106, PALM COAST, FL 32137-8260
(386) 446-6540
(386) 447-7732
Mailing address
19 OLD KINGS RD N, SUITE C-106, PALM COAST, FL 32137-8260
(386) 446-6540
(386) 447-7732
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
ME80454
FL
207RI0011X
Interventional Cardiology Physician
Primary
ME80454
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17609
BLUE CROSS BLUE SHIELD
FL
01
—
AX630
MEDICARE GROUP NUMBER
FL
Enumeration date
04/14/2006
Last updated
12/18/2008
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