Provider Demographics
NPI:1760760466
Name:MARQUE, JOACHIM (LAC)
Entity Type:Individual
Prefix:MR
First Name:JOACHIM
Middle Name:
Last Name:MARQUE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21210 COSTANSO ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2034
Mailing Address - Country:US
Mailing Address - Phone:818-203-7377
Mailing Address - Fax:818-889-5816
Practice Address - Street 1:21210 COSTANSO ST
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2034
Practice Address - Country:US
Practice Address - Phone:818-203-7377
Practice Address - Fax:818-889-5816
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-28
Last Update Date:2018-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14045171100000X
CAAC14045171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty