Provider Demographics
NPI:1275035925
Name:NEZ, MARC
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:NEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7324 WILLIAMSBURG RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4556
Mailing Address - Country:US
Mailing Address - Phone:505-720-6395
Mailing Address - Fax:
Practice Address - Street 1:2716 SAN PEDRO DR NE STE D
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3331
Practice Address - Country:US
Practice Address - Phone:505-720-6395
Practice Address - Fax:505-421-7709
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-07
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6292235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM88737012Medicaid