Individual
DESMOND JACOB MARROQUIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
420 POLIFKA DR, SHAW AFB, SC 29152-5100
(803) 885-0249
Mailing address
420 POLIFKA DR, SHAW AFB, SC 29152-5100
(803) 885-0249
Taxonomy
Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary
—
—
Other
Enumeration date
09/09/2021
Last updated
11/26/2024
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