Provider Demographics
NPI:1538278239
Name:MAREZ, DANIEL (DOM)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:MAREZ
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 COOK AVE
Mailing Address - Street 2:
Mailing Address - City:RATON
Mailing Address - State:NM
Mailing Address - Zip Code:87740
Mailing Address - Country:US
Mailing Address - Phone:505-445-1037
Mailing Address - Fax:505-445-1041
Practice Address - Street 1:210 COOK AVE
Practice Address - Street 2:
Practice Address - City:RATON
Practice Address - State:NM
Practice Address - Zip Code:87740
Practice Address - Country:US
Practice Address - Phone:505-445-1037
Practice Address - Fax:505-445-1041
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM538171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM01R472OtherBLUE CROSS BLUE SHIELD