Healthcare Provider Details

I. General information

NPI: 1194665331
Provider Name (Legal Business Name): MARQUEL HAGANS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY OF NEW MEXICO, MSC06 3500
ALBUQUERQUE NM
81731
US

IV. Provider business mailing address

670 RHODE ISLAND AVE NE APT 210A
WASHINGTON DC
20002-1492
US

V. Phone/Fax

Practice location:
  • Phone: 505-925-4031
  • Fax:
Mailing address:
  • Phone: 704-303-5868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: