Provider Demographics
NPI:1912193483
Name:MARQUEZ, BEATRIZ A
Entity Type:Individual
Prefix:MRS
First Name:BEATRIZ
Middle Name:A
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1781 BAYBERRY LN
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-5263
Mailing Address - Country:US
Mailing Address - Phone:661-839-2946
Mailing Address - Fax:209-938-0281
Practice Address - Street 1:1781 BAYBERRY LN
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-5263
Practice Address - Country:US
Practice Address - Phone:661-839-2946
Practice Address - Fax:209-938-0281
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA-5146101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)