Healthcare Provider Details

I. General information

NPI: 1215905369
Provider Name (Legal Business Name): JOVEN MARQUEZ ZANO IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 561 BOX 1001 FPO AP 96310
IWAKUNI YAMAGUCHI
96310
JP

IV. Provider business mailing address

6431 SEWELLS POINT RD
NORFOLK VA
23513-3217
US

V. Phone/Fax

Practice location:
  • Phone: 81827214171
  • Fax: 2535122
Mailing address:
  • Phone: 757-343-2234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: