Provider Demographics
NPI:1598003337
Name:SANTOS, JOSE ANTONIO MARQUEZ (NP-C)
Entity Type:Individual
Prefix:
First Name:JOSE ANTONIO
Middle Name:MARQUEZ
Last Name:SANTOS
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10541 ARIANNE DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-4378
Mailing Address - Country:US
Mailing Address - Phone:209-390-1265
Mailing Address - Fax:
Practice Address - Street 1:10541 ARIANNE DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-4378
Practice Address - Country:US
Practice Address - Phone:209-390-1265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-30
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22699363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner