Provider Demographics
NPI:1457620866
Name:MARQUEZ, TANIA (RBT)
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 W 79TH PL
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-3573
Mailing Address - Country:US
Mailing Address - Phone:786-537-1921
Mailing Address - Fax:
Practice Address - Street 1:965 W 79TH PL
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-3573
Practice Address - Country:US
Practice Address - Phone:786-537-1921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 66173225700000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist