Provider Demographics
NPI:1659488120
Name:ASISTORES-QUILON, MARILYN (MD, PA)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:
Last Name:ASISTORES-QUILON
Suffix:
Gender:F
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 S CLOSNER BLVD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-5668
Mailing Address - Country:US
Mailing Address - Phone:956-316-0860
Mailing Address - Fax:956-316-1073
Practice Address - Street 1:1400 S CLOSNER BLVD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-5668
Practice Address - Country:US
Practice Address - Phone:956-316-0860
Practice Address - Fax:956-316-1073
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2485207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137175905Medicaid
TX742967614OtherTAX ID
TX8AJ940OtherBCBS
TX137175909OtherTHSTEPS
TX742967614OtherTAX ID
TX137175905Medicaid
TX137175909OtherTHSTEPS