Provider Demographics
NPI:1518131580
Name:MARQUIS, DAVID RANDALL (COUNSELOR)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:RANDALL
Last Name:MARQUIS
Suffix:
Gender:M
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 E G ST STE 111
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-2943
Mailing Address - Country:US
Mailing Address - Phone:909-430-0923
Mailing Address - Fax:909-430-0923
Practice Address - Street 1:128 E G ST STE 111
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-2943
Practice Address - Country:US
Practice Address - Phone:909-430-0923
Practice Address - Fax:909-430-0923
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-21
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA360068AN101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA360068ANOtherMEDICAL