Provider Demographics
NPI:1659490449
Name:MARROQUIN ESTRADA, GAYLE ESCARLET (IMF)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:ESCARLET
Last Name:MARROQUIN ESTRADA
Suffix:
Gender:F
Credentials:IMF
Other - Prefix:
Other - First Name:GAYLE
Other - Middle Name:ESCARLET
Other - Last Name:MARROQUIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:815 COLORADO BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-1744
Mailing Address - Country:US
Mailing Address - Phone:323-543-2800
Mailing Address - Fax:323-978-1263
Practice Address - Street 1:50 E FOOTHILL BLVD STE 300
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-2314
Practice Address - Country:US
Practice Address - Phone:626-919-3579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102867106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist