MEDICARE: CAROLINA ROXANA MARQUEZ DPM

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	213EP1101X	Primary Podiatric Medicine Podiatrist	PO4579	FL
2	213ES0103X	Foot & Ankle Surgery Podiatrist	PO4579	FL
3	213ES0131X	Foot Surgery Podiatrist	PO4579	FL
4	213E00000X	Podiatrist	PO4579	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	VZ3JB	OTHER	FL	BCBS FL BLUE

General Provider Information

NPI Number	:	1992381412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINA ROXANA MARQUEZ DPM

Provider Business Mailing Address
First Line	:	15815 SHADDOCK DR STE 130
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-5773
Country	:	US
Telephone Number	:	813-400-1140
Fax Number	:	813-701-9132

Provider Business Practice Location Address
First Line	:	3070 LOOPDALE LN
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-7659
Country	:	US
Telephone Number	:	407-530-3448
Fax Number	:	321-296-6961

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

Provider Enumeration Date	:	03/23/2021
Last Update Date	:	03/10/2025

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Directions to “ CAROLINA ROXANA MARQUEZ DPM” Practice Location

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