Provider Demographics
NPI:1336463942
Name:MARROQUIN, GLORIA
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:
Last Name:MARROQUIN
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 1:341 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-3263
Mailing Address - Country:US
Mailing Address - Phone:714-399-1860
Mailing Address - Fax:714-399-1867
Practice Address - Street 1:341 E CENTER ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-3263
Practice Address - Country:US
Practice Address - Phone:714-399-1860
Practice Address - Fax:714-399-1867
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker