Provider Demographics
NPI:1568089761
Name:CANCEL MARQUEZ, CHAIRA ZURIEL
Entity Type:Individual
Prefix:
First Name:CHAIRA
Middle Name:ZURIEL
Last Name:CANCEL 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 1:607 S OXALIS AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-4714
Mailing Address - Country:US
Mailing Address - Phone:407-844-7817
Mailing Address - Fax:
Practice Address - Street 1:1071 PORT MALABAR BLVD NE STE 106
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-5161
Practice Address - Country:US
Practice Address - Phone:407-730-7983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation