Provider Demographics
NPI:1235424771
Name:LARA-MARQUEZ, MARIA LUZ (MD, PHD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:LUZ
Last Name:LARA-MARQUEZ
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1792 QUEEN CATHERINE LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-4631
Mailing Address - Country:US
Mailing Address - Phone:504-402-9469
Mailing Address - Fax:858-244-7267
Practice Address - Street 1:1792 QUEEN CATHERINE LN
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-4631
Practice Address - Country:US
Practice Address - Phone:504-402-9469
Practice Address - Fax:858-244-7267
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2025-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2025-00855208D00000X
CAA145699208D00000X, 207K00000X
NC2025-0855207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1235424771OtherNPI