Provider Demographics
NPI:1790996411
Name:MARQUEZ & BENGOCHEA
Entity Type:Organization
Organization Name:MARQUEZ & BENGOCHEA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BENGOCHEA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-446-8377
Mailing Address - Street 1:135 MADEIRA AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4515
Mailing Address - Country:US
Mailing Address - Phone:305-446-8377
Mailing Address - Fax:305-567-9126
Practice Address - Street 1:135 MADEIRA AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4515
Practice Address - Country:US
Practice Address - Phone:305-446-8377
Practice Address - Fax:305-567-9126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME502342080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1275597973OtherNPI
FL1689638157OtherNPI
FLE15786Medicare UPIN
FL1689638157OtherNPI