Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 33990 | TX |
Y | 103TC0700X | Clinical Psychologist | 33990 | TX |
N | 103G00000X | Clinical Psychologist | 33990 | TX |
N | 103TC0700X | Clinical Psychologist | 33990 | TX |
N | 103TR0400X | Rehabilitation Psychologist | 33990 | TX |
NPI | 1629223557 |
---|---|
Provider Name | Dr. Carlos Daniel Marquez De La Plata |
First Address | Dallas, TX 75244-5257 |
Second Address | Dallas, TX 75244-5257 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2008 |
Last Update Date | 16/04/2019 |