Healthcare Provider Details

I. General information

NPI: 1770021347
Provider Name (Legal Business Name): MARIA GABRIELA MARQUEZ PSYD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CUPEY GARDEN PLAZA 200 URB CUPEY GARDEN SERVICIOS PSICOLOGICOS RAIGAMBRE
SAN JUAN PR
00926
US

IV. Provider business mailing address

3 CUPEY GARDEN PLAZA 200 URB CUPEY GARDEN SERVICIOS PSICOLOGICOS RAIGAMBRE
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-292-0205
  • Fax:
Mailing address:
  • Phone: 787-292-0205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5687
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: