Provider Demographics
NPI:1417515644
Name:MARQUEZ, KRYSTOVIA EVETH
Entity Type:Individual
Prefix:MRS
First Name:KRYSTOVIA
Middle Name:EVETH
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 1:2 N MARKET ST STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95113-1211
Mailing Address - Country:US
Mailing Address - Phone:510-210-3233
Mailing Address - Fax:
Practice Address - Street 1:2 N MARKET ST STE 300
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95113-1211
Practice Address - Country:US
Practice Address - Phone:510-210-3233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1689714198OtherMEDICAL