MEDICARE: MS. AMELIA MARIA MARQUEZ LISW 1-0916

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1699928002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMELIA MARIA MARQUEZ LISW 1-0916

Provider Business Mailing Address
First Line	:	1929 LOPEZ STREET
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	82201
Country	:	US
Telephone Number	:	505-425-8559
Fax Number	:

Provider Business Practice Location Address
First Line	:	2007 LOPEZ STREET
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701
Country	:	US
Telephone Number	:	505-452-8559
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2008
Last Update Date	:	10/29/2008

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