Provider Demographics
NPI:1295413631
Name:MARQUEZ, JUANITA ROSE
Entity type:Individual
Prefix:
First Name:JUANITA
Middle Name:ROSE
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 SW CEDARWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-6818
Mailing Address - Country:US
Mailing Address - Phone:503-435-1550
Mailing Address - Fax:
Practice Address - Street 1:1075 SW CEDARWOOD AVE
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-6818
Practice Address - Country:US
Practice Address - Phone:503-883-9865
Practice Address - Fax:503-435-1435
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator