Provider Demographics
NPI:1528301496
Name:MARQUEZ, JUAN L (MS)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:L
Last Name:MARQUEZ
Suffix:
Gender:M
Credentials:MS
Other - Prefix:MR
Other - First Name:JUAN
Other - Middle Name:L
Other - Last Name:MARQUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:9710 E INDIGO ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-5611
Mailing Address - Country:US
Mailing Address - Phone:305-232-6003
Mailing Address - Fax:305-232-6092
Practice Address - Street 1:9710 E INDIGO ST
Practice Address - Street 2:SUITE 301
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-5611
Practice Address - Country:US
Practice Address - Phone:305-232-6003
Practice Address - Fax:305-232-6092
Is Sole Proprietor?:No
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health