Provider Demographics
NPI:1679749220
Name:MARQUEZ, CHRISTOPHER J (IDC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:J
Last Name:MARQUEZ
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4004 PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-8822
Mailing Address - Country:US
Mailing Address - Phone:757-971-2356
Mailing Address - Fax:
Practice Address - Street 1:1840 GATOR BLVD
Practice Address - Street 2:SEAL TEAM TWO BLDG 3841
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23521
Practice Address - Country:US
Practice Address - Phone:757-763-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman