Provider Demographics
NPI:1235898412
Name:MARQUEZ MORENO, MARIA CAROLINA (SA-C)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:CAROLINA
Last Name:MARQUEZ MORENO
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 1:8661 DAYDREAM ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-2401
Mailing Address - Country:US
Mailing Address - Phone:941-447-2266
Mailing Address - Fax:
Practice Address - Street 1:8661 DAYDREAM ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-2401
Practice Address - Country:US
Practice Address - Phone:941-447-2266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21-565246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty