Provider Demographics
NPI:1801788609
Name:VIDAL MARQUEZ, CARMEN JULIA
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:JULIA
Last Name:VIDAL MARQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2944 SUNSET VISTA BLVD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34747
Mailing Address - Country:US
Mailing Address - Phone:973-459-6069
Mailing Address - Fax:973-459-6069
Practice Address - Street 1:2944 SUNSET VISTA BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34747
Practice Address - Country:US
Practice Address - Phone:973-459-6069
Practice Address - Fax:973-459-6069
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2687-P.A.363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant