Provider Demographics
NPI:1376920652
Name:MARQUEZ, LORENA
Entity Type:Individual
Prefix:MRS
First Name:LORENA
Middle Name:
Last Name:MARQUEZ
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 1:1055 NOLBEY ST
Mailing Address - Street 2:
Mailing Address - City:CARDIFF
Mailing Address - State:CA
Mailing Address - Zip Code:92007-1150
Mailing Address - Country:US
Mailing Address - Phone:760-936-6462
Mailing Address - Fax:
Practice Address - Street 1:1055 NOLBEY ST
Practice Address - Street 2:
Practice Address - City:CARDIFF
Practice Address - State:CA
Practice Address - Zip Code:92007-1150
Practice Address - Country:US
Practice Address - Phone:760-936-6462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility