Provider Demographics
NPI:1235424771
Name:LARA-MARQUEZ, MARIA LUZ (MD, PHD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:LUZ
Last Name:LARA-MARQUEZ
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3675 RUFFIN RD STE 120
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1870
Mailing Address - Country:US
Mailing Address - Phone:504-402-9469
Mailing Address - Fax:888-939-4213
Practice Address - Street 1:3675 RUFFIN RD STE 120
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1870
Practice Address - Country:US
Practice Address - Phone:504-402-9469
Practice Address - Fax:888-939-4213
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA145699208D00000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1235424771OtherNPI