MEDICARE: DR. CHARLES DANIEL MARQUEZ PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	38070	TX

General Provider Information

NPI Number	:	1629607890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES DANIEL MARQUEZ PSY.D.

Provider Business Mailing Address
First Line	:	PO BOX 1134
Second Line	:
City	:	AZTEC
State	:	NM
Zip	:	87410-1134
Country	:	US
Telephone Number	:	505-407-5852
Fax Number	:

Provider Business Practice Location Address
First Line	:	1209 MOUNTAIN ROAD PL NE STE R
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-7845
Country	:	US
Telephone Number	:	505-407-5852
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2020
Last Update Date	:	07/03/2025

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