Healthcare Provider Details

I. General information

NPI: 1932012598
Provider Name (Legal Business Name): CARLOS MARQUEZ PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 COUNTY ROAD D E STE B
SAINT PAUL MN
55109-5358
US

IV. Provider business mailing address

2103 COUNTY ROAD D E STE B
MAPLEWOOD MN
55109-5358
US

V. Phone/Fax

Practice location:
  • Phone: 651-748-5019
  • Fax:
Mailing address:
  • Phone: 612-915-0049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: