Provider Demographics
NPI:1487787883
Name:C MARZOUKA PROFESSIONAL SERVICES INC
Entity type:Organization
Organization Name:C MARZOUKA PROFESSIONAL SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARZOUKA-LOSITO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:305-389-3262
Mailing Address - Street 1:6802 SW 144TH TER
Mailing Address - Street 2:
Mailing Address - City:VILLAGE OF PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33158-1728
Mailing Address - Country:US
Mailing Address - Phone:305-389-3262
Mailing Address - Fax:305-259-2979
Practice Address - Street 1:15101 S.W 87 AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157
Practice Address - Country:US
Practice Address - Phone:305-232-1209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2792213ES0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports MedicineGroup - Single Specialty