Provider Demographics
NPI:1538108691
Name:MARQUEZ, YGNACIO (PA)
Entity Type:Individual
Prefix:
First Name:YGNACIO
Middle Name:
Last Name:MARQUEZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3941 J ST
Mailing Address - Street 2:SUITE 270
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3628
Mailing Address - Country:US
Mailing Address - Phone:916-733-6850
Mailing Address - Fax:916-733-6824
Practice Address - Street 1:3941 J ST
Practice Address - Street 2:SUITE 270
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3628
Practice Address - Country:US
Practice Address - Phone:916-733-6850
Practice Address - Fax:916-733-6824
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA10016363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA10016Medicaid
CAPA10016Medicaid