Provider Demographics
NPI:1386520112
Name:MARQUEZ, DIANA ALEXIS
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:ALEXIS
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 1:2301 E FORT MACON RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28512-5633
Mailing Address - Country:US
Mailing Address - Phone:830-734-3476
Mailing Address - Fax:
Practice Address - Street 1:2301 E FORT MACON RD
Practice Address - Street 2:
Practice Address - City:ATLANTIC BEACH
Practice Address - State:NC
Practice Address - Zip Code:28512-5633
Practice Address - Country:US
Practice Address - Phone:830-734-3476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians