Provider Demographics
NPI:1518120435
Name:MARQUEZ GRACIANI, JAVIER (MD)
Entity Type:Individual
Prefix:DR
First Name:JAVIER
Middle Name:
Last Name:MARQUEZ GRACIANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JAVIER
Other - Middle Name:
Other - Last Name:MARQUEZ GRACIANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:14 CALLE PERAL N STE IC
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-4861
Mailing Address - Country:US
Mailing Address - Phone:787-986-7325
Mailing Address - Fax:
Practice Address - Street 1:14 CALLE PERAL N STE IC
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4861
Practice Address - Country:US
Practice Address - Phone:787-986-7325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17272208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR17272Medicaid