Provider Demographics
NPI:1922489905
Name:MARQUEZ, GUSTAVO
Entity Type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:
Last Name:MARQUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 NUTMEG PL
Mailing Address - Street 2:APT K6
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-5161
Mailing Address - Country:US
Mailing Address - Phone:775-686-3146
Mailing Address - Fax:
Practice Address - Street 1:950 NUTMEG PL
Practice Address - Street 2:APT K6
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-5161
Practice Address - Country:US
Practice Address - Phone:775-686-3146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health