Provider Demographics
NPI:1437452646
Name:MARQUEZ, DORY C
Entity Type:Individual
Prefix:
First Name:DORY
Middle Name:C
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 E GRIFFIN PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3042
Mailing Address - Country:US
Mailing Address - Phone:956-581-6969
Mailing Address - Fax:
Practice Address - Street 1:1922 E GRIFFIN PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3042
Practice Address - Country:US
Practice Address - Phone:956-581-6969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-09
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010113251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679515OtherMEDICARE PROVIDER NUMBER