Provider Demographics
NPI:1366862559
Name:MARQUEZ, JUANITA (ATC)
Entity Type:Individual
Prefix:MS
First Name:JUANITA
Middle Name:
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 SAINT JOSEPHS DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1712
Mailing Address - Country:US
Mailing Address - Phone:505-831-8421
Mailing Address - Fax:
Practice Address - Street 1:5301 SAINT JOSEPHS DR NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1712
Practice Address - Country:US
Practice Address - Phone:505-831-8421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-26
Last Update Date:2014-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5172255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer