Healthcare Provider Details

I. General information

NPI: 1790996411
Provider Name (Legal Business Name): MARQUEZ & BENGOCHEA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 MADEIRA AVE
CORAL GABLES FL
33134-4515
US

IV. Provider business mailing address

135 MADEIRA AVE
CORAL GABLES FL
33134-4515
US

V. Phone/Fax

Practice location:
  • Phone: 305-446-8377
  • Fax: 305-567-9126
Mailing address:
  • Phone: 305-446-8377
  • Fax: 305-567-9126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberME50234
License Number StateFL

VIII. Authorized Official

Name: JOSE A BENGOCHEA
Title or Position: PHYSICIAN
Credential: MD
Phone: 305-446-8377