Provider Demographics
NPI:1851129480
Name:MARQUEZ, DESIRE
Entity type:Individual
Prefix:MRS
First Name:DESIRE
Middle Name:
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4484 SW GAINSBORO ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-6547
Mailing Address - Country:US
Mailing Address - Phone:723-619-0427
Mailing Address - Fax:
Practice Address - Street 1:2290 N RONALD REAGAN BLVD
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-3534
Practice Address - Country:US
Practice Address - Phone:407-215-0095
Practice Address - Fax:321-639-1194
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health