Provider Demographics
NPI:1174762751
Name:MARINE, LEOPOLDO ARIO FERNANDO
Entity type:Individual
Prefix:DR
First Name:LEOPOLDO
Middle Name:ARIO FERNANDO
Last Name:MARINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6713 BLAISE CENDRARS
Mailing Address - Street 2:
Mailing Address - City:SANTIAGO
Mailing Address - State:VITACURA
Mailing Address - Zip Code:7650518
Mailing Address - Country:CL
Mailing Address - Phone:562-793-5814
Mailing Address - Fax:562-632-6812
Practice Address - Street 1:367 MARCOLETA
Practice Address - Street 2:8TH FLLOR
Practice Address - City:SANTIAGO
Practice Address - State:SANTIAGO
Practice Address - Zip Code:8330024
Practice Address - Country:CL
Practice Address - Phone:562-354-3268
Practice Address - Fax:562-632-6812
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040101802086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery