Basic Information
| Provider Information | |||||||||
| NPI: | 1073541835 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARROQUIN | ||||||||
| FirstName: | SANTIAGO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1607 NORTH MAIN ST | ||||||||
| Address2: | |||||||||
| City: | VICTORIA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 779015213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3615762116 | ||||||||
| FaxNumber: | 3615765020 | ||||||||
| Practice Location | |||||||||
| Address1: | 506 E SAN ANTONIO ST | ||||||||
| Address2: | |||||||||
| City: | VICTORIA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3615757441 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | L3006 | TX | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.