Provider Demographics
NPI:1912102583
Name:MARROQUIN, JACLYN TERESA (MD)
Entity Type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:TERESA
Last Name:MARROQUIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 SAINT DAVIDS LOOP STE 320
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-5225
Mailing Address - Country:US
Mailing Address - Phone:737-843-7533
Mailing Address - Fax:737-843-7535
Practice Address - Street 1:505 SAINT DAVIDS LOOP STE 320
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-5225
Practice Address - Country:US
Practice Address - Phone:737-843-7533
Practice Address - Fax:737-843-7535
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10026814208000000X
TXN3867208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX206278803Medicaid
3891389930OtherMYUTMB 3891389930-COMMERCIAL NUMBER
TX206278803Medicaid