Provider Demographics
NPI:1649002627
Name:MARQUEZ, JUDY (CPSW)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:CPSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 WYOMING BLVD NE STE J
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2646
Mailing Address - Country:US
Mailing Address - Phone:505-389-7129
Mailing Address - Fax:
Practice Address - Street 1:2015 WYOMING BLVD NE STE J
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2646
Practice Address - Country:US
Practice Address - Phone:505-389-7129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-17
Last Update Date:2024-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM50366987175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist