Provider Demographics
NPI:1669156360
Name:MARROQUIN, JOSE EDUARDO
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:EDUARDO
Last Name:MARROQUIN
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 RAILROAD ST APT 127
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-3513
Mailing Address - Country:US
Mailing Address - Phone:909-680-9710
Mailing Address - Fax:
Practice Address - Street 1:950 RAILROAD ST APT 127
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-3513
Practice Address - Country:US
Practice Address - Phone:909-680-9710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer