Provider Demographics
NPI:1053478438
Name:MARLON ORLANDO BOQUIN
Entity Type:Organization
Organization Name:MARLON ORLANDO BOQUIN
Other - Org Name:BOMAR MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARLON
Authorized Official - Middle Name:ORLANDO
Authorized Official - Last Name:BOQUIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-463-5382
Mailing Address - Street 1:10085 WESTPARK DR
Mailing Address - Street 2:STE A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-5900
Mailing Address - Country:US
Mailing Address - Phone:713-463-5382
Mailing Address - Fax:713-463-5496
Practice Address - Street 1:10085 WESTPARK DR
Practice Address - Street 2:STE A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-5900
Practice Address - Country:US
Practice Address - Phone:713-463-5382
Practice Address - Fax:713-463-5496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0056491332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX147562601Medicaid
TX147562601Medicaid