Provider Demographics
NPI:1669499612
Name:STA ANA, ENRIQUE MARQUEZ V (MD)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:MARQUEZ
Last Name:STA ANA
Suffix:V
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ENRIQUE
Other - Middle Name:M
Other - Last Name:SANTA ANA
Other - Suffix:V
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1140 BUSINESS CENTER DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-2737
Mailing Address - Country:US
Mailing Address - Phone:713-464-1981
Mailing Address - Fax:713-464-1131
Practice Address - Street 1:1140 BUSINESS CENTER DR
Practice Address - Street 2:SUITE 400
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043
Practice Address - Country:US
Practice Address - Phone:713-464-1981
Practice Address - Fax:713-464-1131
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ5284208600000X
MA220820208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8FJ546OtherBCBS TX
TX348879301Medicaid
TX348879301Medicaid
MAST A39991Medicare ID - Type Unspecified
MA2122154Medicaid