Provider Demographics
NPI:1568908994
Name:MARQUEZ, JASMINE (MPH, IBCLC)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:MPH, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3038 FLINT ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-1625
Mailing Address - Country:US
Mailing Address - Phone:510-305-1854
Mailing Address - Fax:
Practice Address - Street 1:3038 FLINT ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-1625
Practice Address - Country:US
Practice Address - Phone:510-305-1854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-110102174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN