Basic Information
| Provider Information | |||||||||
| NPI: | 1033136023 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JOSE R. MARQUINA, M.D., P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 111179 | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341080120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2395925864 | ||||||||
| FaxNumber: | 2395926214 | ||||||||
| Practice Location | |||||||||
| Address1: | 1855 VETERANS PARK DR | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341090446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2395925864 | ||||||||
| FaxNumber: | 2395926214 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2006 | ||||||||
| LastUpdateDate: | 08/09/2011 | ||||||||
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| AuthorizedOfficialLastName: | MARQUINA | ||||||||
| AuthorizedOfficialFirstName: | JOSE | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2395925864 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D., F.C.C.P. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | 179809 | FL | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | 179809 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 262112600 | 05 | FL | MEDICAID |