Healthcare Provider Details

I. General information

NPI: 1700366945
Provider Name (Legal Business Name): AMADA ROCIO MARQUEZ IV AMADA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. AMADA ROCIO MARQUEZ

II. Dates (important events)

Enumeration Date: 08/16/2018
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CORAL REEF TER
GAITHERSBURG MD
20878-2977
US

IV. Provider business mailing address

101 CORAL REEF TER
GAITHERSBURG MD
20878-2977
US

V. Phone/Fax

Practice location:
  • Phone: 240-813-5892
  • Fax:
Mailing address:
  • Phone: 240-813-5892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberCNA20180764
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: