=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588797849
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOURDES A MARQUEZ AND CRISTINA ANDIA RABO PTR
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2007
-----------------------------------------------------
Last Update Date | 08/30/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5409 AVE O SUITE 120
-----------------------------------------------------
City | FT MADISON
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-372-7992
-----------------------------------------------------
Fax | 319-372-9641
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5409 AVE O SUITE 120
-----------------------------------------------------
City | FT MADISON
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-372-7992
-----------------------------------------------------
Fax | 319-372-9641
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | LOURDES A MARQUEZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 319-372-7992
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------