Provider Demographics
NPI:1083028179
Name:MARQUZ, KRYSTIN ANN
Entity Type:Individual
Prefix:
First Name:KRYSTIN
Middle Name:ANN
Last Name:MARQUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3469 W BENJAMIN HOLT DR APT 474
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-3539
Mailing Address - Country:US
Mailing Address - Phone:209-968-1598
Mailing Address - Fax:
Practice Address - Street 1:3469 W BENJAMIN HOLT DR APT 474
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-3539
Practice Address - Country:US
Practice Address - Phone:209-968-1598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT37594247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other