Provider Demographics
NPI:1063987279
Name:MARQUEZ ROSARIO, MICHELLE MARIE (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:MARQUEZ ROSARIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:#64B GOYCO STREET
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-746-2530
Mailing Address - Fax:
Practice Address - Street 1:CARR 188 # 187
Practice Address - Street 2:
Practice Address - City:LOIZA
Practice Address - State:PR
Practice Address - Zip Code:00772-1850
Practice Address - Country:US
Practice Address - Phone:787-876-2042
Practice Address - Fax:787-256-1900
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-04
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22356207Q00000X, 390200000X, 207QG0300X
PR34968207Q00000X
PR15245-I207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5027105OtherLICENSE IDENTIFICATION