Healthcare Provider Details

I. General information

NPI: 1275421711
Provider Name (Legal Business Name): SANDRA ROCIO MARQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4645 GUN CLUB RD STE 12
WEST PALM BEACH FL
33415-2833
US

IV. Provider business mailing address

2061 VININGS CIR APT 1422
WELLINGTON FL
33414-2078
US

V. Phone/Fax

Practice location:
  • Phone: 352-216-5850
  • Fax:
Mailing address:
  • Phone: 352-216-5850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ12701
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: