Provider Demographics
NPI:1447809108
Name:MARQUEZ, TERESA R
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:R
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:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:ANTHONY
Mailing Address - State:NM
Mailing Address - Zip Code:88021-0070
Mailing Address - Country:US
Mailing Address - Phone:575-882-6101
Mailing Address - Fax:
Practice Address - Street 1:330 HOLGUIN RD
Practice Address - Street 2:
Practice Address - City:VADO
Practice Address - State:NM
Practice Address - Zip Code:88072-7220
Practice Address - Country:US
Practice Address - Phone:575-233-2861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCF6904235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist