Provider Demographics
NPI:1841383270
Name:MARROQUIN, LIZA (MD MBA)
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:
Last Name:MARROQUIN
Suffix:
Gender:F
Credentials:MD MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3753
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92067-3753
Mailing Address - Country:US
Mailing Address - Phone:619-962-2323
Mailing Address - Fax:858-759-5696
Practice Address - Street 1:750 MEDICAL CENTER CT
Practice Address - Street 2:SUITE 101
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6634
Practice Address - Country:US
Practice Address - Phone:619-421-3313
Practice Address - Fax:619-421-3315
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA87894207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine