Provider Demographics
NPI:1700366945
Name:MARQUEZ, AMADA ROCIO IV (AMADA)
Entity Type:Individual
Prefix:MS
First Name:AMADA
Middle Name:ROCIO
Last Name:MARQUEZ
Suffix:IV
Gender:F
Credentials:AMADA
Other - Prefix:MS
Other - First Name:AMADA
Other - Middle Name:ROCIO
Other - Last Name:MARQUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:101 CORAL REEF TER
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2977
Mailing Address - Country:US
Mailing Address - Phone:240-813-5892
Mailing Address - Fax:
Practice Address - Street 1:101 CORAL REEF TER
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-2977
Practice Address - Country:US
Practice Address - Phone:240-813-5892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCNA20180764376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide