Provider Demographics
NPI:1578561338
Name:ALQUIZA, MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:ALQUIZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 E TIDWELL RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77022-1822
Mailing Address - Country:US
Mailing Address - Phone:713-691-0035
Mailing Address - Fax:713-691-2448
Practice Address - Street 1:720 E TIDWELL RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77022-1822
Practice Address - Country:US
Practice Address - Phone:713-691-0035
Practice Address - Fax:713-691-2448
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9067207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173024401Medicaid
TX173024403Medicaid
TX502302YLPSOtherWELLMED PTAN
TXG75115Medicare UPIN