1669499612 NPI number — ENRIQUE MARQUEZ STA ANA V MD

Table of content: ENRIQUE MARQUEZ STA ANA V MD (NPI 1669499612)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669499612 NPI number — ENRIQUE MARQUEZ STA ANA V MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STA ANA
Provider First Name:
ENRIQUE
Provider Middle Name:
MARQUEZ
Provider Name Prefix Text:
Provider Name Suffix Text:
V
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SANTA ANA
Provider Other First Name:
ENRIQUE
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
V
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1669499612
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1140 BUSINESS CENTER DR
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77043-2737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-464-1981
Provider Business Mailing Address Fax Number:
713-464-1131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1140 BUSINESS CENTER DR
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-464-1981
Provider Business Practice Location Address Fax Number:
713-464-1131
Provider Enumeration Date:
07/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  Q5284 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8FJ546 . This is a "BCBS TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 348879301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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