Provider Demographics
NPI:1376978098
Name:MARQUEZ PANTOJA, MARIELA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIELA
Middle Name:
Last Name:MARQUEZ PANTOJA
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:PO BOX 1819
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-1819
Mailing Address - Country:US
Mailing Address - Phone:787-226-9182
Mailing Address - Fax:
Practice Address - Street 1:26 CALLE MARTINEZ
Practice Address - Street 2:
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777-3502
Practice Address - Country:US
Practice Address - Phone:787-734-8042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2019-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR29470R208D00000X
PR19598207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice