Provider Demographics
NPI:1275579344
Name:MARQUES, ANTONIA HERMINIA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIA
Middle Name:HERMINIA
Last Name:MARQUES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LA CUMBRE GDS APT.105,CALLE SANTA ROSA#200
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:178-772-0693
Mailing Address - Fax:178-727-1377
Practice Address - Street 1:LA CUMBRE GDS APT.105,CALLE SANTA ROSA#200
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:178-772-0693
Practice Address - Fax:178-727-1377
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6082207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE14385Medicare UPIN