Provider Demographics
NPI:1194203752
Name:MARQUEZ MORALES, DENNICE OLIVIA (SA-C)
Entity Type:Individual
Prefix:
First Name:DENNICE
Middle Name:OLIVIA
Last Name:MARQUEZ MORALES
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 WESTCITY CT APT 276
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-1626
Mailing Address - Country:US
Mailing Address - Phone:915-503-7189
Mailing Address - Fax:
Practice Address - Street 1:4111 WESTCITY CT APT 276
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-1626
Practice Address - Country:US
Practice Address - Phone:915-503-7189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-04
Last Update Date:2018-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18-338246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant