Provider Demographics
NPI:1164669123
Name:MARQUEZ, GUADALUPE (DDS)
Entity Type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2452 FENTON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-4551
Mailing Address - Country:US
Mailing Address - Phone:619-423-6116
Mailing Address - Fax:619-423-6149
Practice Address - Street 1:2452 FENTON ST STE 200
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914
Practice Address - Country:US
Practice Address - Phone:619-423-6116
Practice Address - Fax:619-423-6149
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38716122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist