Provider Demographics
NPI:1124217633
Name:MARROQUIN, YESSENIA ESMERALDA (R,D)
Entity Type:Individual
Prefix:
First Name:YESSENIA
Middle Name:ESMERALDA
Last Name:MARROQUIN
Suffix:
Gender:F
Credentials:R,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2048 W 154TH ST
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-4223
Mailing Address - Country:US
Mailing Address - Phone:310-225-5602
Mailing Address - Fax:
Practice Address - Street 1:7646 DENSMORE AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-2046
Practice Address - Country:US
Practice Address - Phone:818-994-1288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-20
Last Update Date:2007-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA919970133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered