Provider Demographics
NPI:1124223656
Name:MARROQUIN, ALICIA RODRIGUEZ (RN, MA, CNS, PHD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:RODRIGUEZ
Last Name:MARROQUIN
Suffix:
Gender:F
Credentials:RN, MA, CNS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 WINSOR AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-3643
Mailing Address - Country:US
Mailing Address - Phone:360-473-7777
Mailing Address - Fax:
Practice Address - Street 1:1216 WINSOR AVE
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-3643
Practice Address - Country:US
Practice Address - Phone:360-473-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
NC167681163WP0808X
WARN00069310163WP0808X
OR200943348RN163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral