Healthcare Provider Details

I. General information

NPI: 1669720959
Provider Name (Legal Business Name): JUAN CARLOS MARQUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2012
Last Update Date: 08/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY DISTRICT HOSPITAL PUERTO RICO MEDICAL CENTER BO. MONACILLOS
SAN JUAN PR
00935-0001
US

IV. Provider business mailing address

PO BOX 2116
SAN JUAN PR
00922-2116
US

V. Phone/Fax

Practice location:
  • Phone: 787-754-0101
  • Fax:
Mailing address:
  • Phone: 787-754-0101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number203 E
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: