Provider Demographics
NPI:1558382754
Name:MARQUEZ-VALEDON, GUILLERMO A (MD)
Entity Type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:A
Last Name:MARQUEZ-VALEDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1905 W 35TH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4500
Mailing Address - Country:US
Mailing Address - Phone:786-464-5555
Mailing Address - Fax:305-820-3503
Practice Address - Street 1:1905 W 35TH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4500
Practice Address - Country:US
Practice Address - Phone:786-464-5555
Practice Address - Fax:305-820-3503
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2013-06-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME103529207QG0300X
PR12627207QG0300X
NC2009-01363207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG65086Medicare UPIN