=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699928002
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMELIA MARIA MARQUEZ LISW 1-0916
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2008
-----------------------------------------------------
Last Update Date | 10/29/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2007 LOPEZ STREET
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-452-8559
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1929 LOPEZ STREET
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 82201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-425-8559
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------