Provider Demographics
NPI:1568979607
Name:MARROQUIN, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MARROQUIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8005 S FIGUEROA ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90003-2720
Mailing Address - Country:US
Mailing Address - Phone:323-568-5400
Mailing Address - Fax:323-752-8031
Practice Address - Street 1:8005 S FIGUEROA ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90003-2720
Practice Address - Country:US
Practice Address - Phone:323-568-5400
Practice Address - Fax:323-752-8031
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)