Provider Demographics
NPI:1720357361
Name:IRMA MARQUEZ
Entity Type:Organization
Organization Name:IRMA MARQUEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STNA
Authorized Official - Prefix:MS
Authorized Official - First Name:IRMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-233-7111
Mailing Address - Street 1:1015 E 33RD ST
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44055
Mailing Address - Country:US
Mailing Address - Phone:440-233-7111
Mailing Address - Fax:
Practice Address - Street 1:1015 E 33RD ST
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44055-1507
Practice Address - Country:US
Practice Address - Phone:440-233-7111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401306241011261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center