Provider Demographics
NPI:1629223557
Name:MARQUEZ DE LA PLATA, CARLOS DANIEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:DANIEL
Last Name:MARQUEZ DE LA PLATA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 MCEWEN RD STE 318
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-5257
Mailing Address - Country:US
Mailing Address - Phone:469-975-2411
Mailing Address - Fax:
Practice Address - Street 1:4101 MCEWEN RD STE 318
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-5257
Practice Address - Country:US
Practice Address - Phone:469-975-2411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33990103TC0700X, 103TR0400X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation