Provider Demographics
NPI:1679950695
Name:MARQUEZ MENDOZA, OTTO (MD PA)
Entity Type:Individual
Prefix:
First Name:OTTO
Middle Name:
Last Name:MARQUEZ MENDOZA
Suffix:
Gender:M
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 1:13801 SW 34TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-7210
Mailing Address - Country:US
Mailing Address - Phone:305-431-1376
Mailing Address - Fax:305-470-1853
Practice Address - Street 1:13801 SW 34TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-7210
Practice Address - Country:US
Practice Address - Phone:305-431-1376
Practice Address - Fax:305-470-1853
Is Sole Proprietor?:No
Enumeration Date:2015-04-28
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL122562207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine