Provider Demographics
NPI:1740964543
Name:DEMARQUEZ, MARIA ELISA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ELISA
Last Name:DEMARQUEZ
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 1:106 COBLESKILL DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4042
Mailing Address - Country:US
Mailing Address - Phone:585-281-4168
Mailing Address - Fax:
Practice Address - Street 1:106 COBLESKILL DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4042
Practice Address - Country:US
Practice Address - Phone:585-281-4168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1629134221174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist