Provider Demographics
NPI:1730331547
Name:MARQUEZ, LIBRADO (CRT,RCP)
Entity type:Individual
Prefix:
First Name:LIBRADO
Middle Name:
Last Name:MARQUEZ
Suffix:
Gender:M
Credentials:CRT,RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8117 COLBI LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76120-5636
Mailing Address - Country:US
Mailing Address - Phone:817-874-1753
Mailing Address - Fax:
Practice Address - Street 1:1860 W MOCKINGBIRD LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-5013
Practice Address - Country:US
Practice Address - Phone:214-353-9090
Practice Address - Fax:214-353-9594
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-13
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX662012278H0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedHome Health