Provider Demographics
NPI:1275065625
Name:MARQUEZ, HARVEY JUNIOR
Entity Type:Individual
Prefix:
First Name:HARVEY
Middle Name:JUNIOR
Last Name:MARQUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 W LA HABRA BLVD
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-5274
Mailing Address - Country:US
Mailing Address - Phone:562-318-4323
Mailing Address - Fax:
Practice Address - Street 1:1510 W LA HABRA BLVD APT 19
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-5263
Practice Address - Country:US
Practice Address - Phone:562-318-4323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADONT KNOW ITOtherMEDI CAL