Provider Demographics
NPI:1801429337
Name:MARQUEZ, JOSE MAXIMO
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:MAXIMO
Last Name:MARQUEZ
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 1:2307 TAXCO CT APT 4
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78542-2480
Mailing Address - Country:US
Mailing Address - Phone:956-707-0482
Mailing Address - Fax:
Practice Address - Street 1:2307 TAXCO CT APT 4
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78542-2480
Practice Address - Country:US
Practice Address - Phone:956-707-0482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty