Provider Demographics
NPI:1407388986
Name:MARQUEZ MENDEZ, MARIA ELENA (BA)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ELENA
Last Name:MARQUEZ MENDEZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7619 32ND AVE S
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-6451
Mailing Address - Country:US
Mailing Address - Phone:786-346-3688
Mailing Address - Fax:
Practice Address - Street 1:7619 32ND AVE S
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-6451
Practice Address - Country:US
Practice Address - Phone:786-346-3688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT-18-59480106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician