Healthcare Provider Details

I. General information

NPI: 1659962132
Provider Name (Legal Business Name): BRIANNE MARQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 01/28/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2441 CABEZON BLVD SE
RIO RANCHO NM
87124-1576
US

IV. Provider business mailing address

2441 CABEZON BLVD SE
RIO RANCHO NM
87124-1576
US

V. Phone/Fax

Practice location:
  • Phone: 505-717-1155
  • Fax: 505-717-1473
Mailing address:
  • Phone: 505-717-1155
  • Fax: 505-717-1473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: