Provider Demographics
NPI:1679259691
Name:MARQUEZ, NICHOLAS MATTHEW DE LA PAZ (MSN, AGACNP-BC)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS MATTHEW
Middle Name:DE LA PAZ
Last Name:MARQUEZ
Suffix:
Gender:M
Credentials:MSN, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15544 FICUS ST
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-3851
Mailing Address - Country:US
Mailing Address - Phone:909-202-2822
Mailing Address - Fax:
Practice Address - Street 1:15544 FICUS ST
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-3851
Practice Address - Country:US
Practice Address - Phone:909-202-2822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021555363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care