Provider Demographics
NPI:1447375787
Name:ELIDA MARQUEZ MD INC
Entity type:Organization
Organization Name:ELIDA MARQUEZ MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALDANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-775-0758
Mailing Address - Street 1:262 SAN JOSE ST
Mailing Address - Street 2:A
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3935
Mailing Address - Country:US
Mailing Address - Phone:831-775-0705
Mailing Address - Fax:831-775-0762
Practice Address - Street 1:262 SAN JOSE ST
Practice Address - Street 2:A
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3935
Practice Address - Country:US
Practice Address - Phone:831-775-0705
Practice Address - Fax:831-775-0762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A694450174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherFEDERAL TAX ID
CAH71572Medicare UPIN
CA00A694450Medicare ID - Type Unspecified