Provider Demographics
NPI:1538466107
Name:MARQUE MEDICAL CLINIC, INC.
Entity Type:Organization
Organization Name:MARQUE MEDICAL CLINIC, INC.
Other - Org Name:MARQUE URGENT CARE, INC.-NEWPORT BEACH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:ARON
Authorized Official - Last Name:KISKILA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-760-9222
Mailing Address - Street 1:2075 SAN JOAQUIN HILLS RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-6505
Mailing Address - Country:US
Mailing Address - Phone:949-760-9222
Mailing Address - Fax:949-644-4312
Practice Address - Street 1:2075 SAN JOAQUIN HILLS RD
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-6505
Practice Address - Country:US
Practice Address - Phone:949-760-9222
Practice Address - Fax:949-644-4312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104532207Q00000X
261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty