Provider Demographics
NPI:1730657636
Name:MARQUEZ FAMILY MEDICINE, LTD.
Entity type:Organization
Organization Name:MARQUEZ FAMILY MEDICINE, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:EMILIO
Authorized Official - Last Name:MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC, AGACNP-BC
Authorized Official - Phone:719-627-3093
Mailing Address - Street 1:103 UNIVERSITY CIR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-1667
Mailing Address - Country:US
Mailing Address - Phone:719-627-3093
Mailing Address - Fax:719-281-3286
Practice Address - Street 1:902 W 29TH ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1159
Practice Address - Country:US
Practice Address - Phone:719-627-3093
Practice Address - Fax:719-281-3286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty