Provider Demographics
NPI:1720524267
Name:MARQUEZ, SAUDHI M (RPT)
Entity Type:Individual
Prefix:
First Name:SAUDHI
Middle Name:M
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:SAUDHI
Other - Middle Name:MUGUETTE
Other - Last Name:MARQUEZ FIGUEROA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPT
Mailing Address - Street 1:407 LAKE HOWELL RD STE 1027
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5908
Mailing Address - Country:US
Mailing Address - Phone:321-972-3755
Mailing Address - Fax:
Practice Address - Street 1:407 LAKE HOWELL RD STE 1039
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5914
Practice Address - Country:US
Practice Address - Phone:321-972-3755
Practice Address - Fax:407-951-6208
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-09
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2582537171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
1720524267OtherRPT