Provider Demographics
NPI:1942326590
Name:OQUENDO, MARIA LUISA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:LUISA
Last Name:OQUENDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 MEDICAL CENTER PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36701-6780
Mailing Address - Country:US
Mailing Address - Phone:334-875-4184
Mailing Address - Fax:334-874-3511
Practice Address - Street 1:7 S OHIO AVE STE 2100
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-6711
Practice Address - Country:US
Practice Address - Phone:609-572-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.25419207P00000X
AL25419207Q00000X
NJ25MA08500800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-14225OtherBLUE CROSS
AL126678Medicaid
AL126678Medicaid