Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | 38070 | TX |
NPI | 1629607890 |
---|---|
Provider Name | Dr. Charles Daniel Marquez |
First Address | Fort Worth, TX 76120-7000 |
Second Address | Fort Worth, TX 76120-7000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2020 |
Last Update Date | 08/04/2020 |