Provider Demographics
NPI:1942945936
Name:MARQUEZ, JAVIER (LMT)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:
Last Name:MARQUEZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 LOS PADRES BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-5128
Mailing Address - Country:US
Mailing Address - Phone:408-205-9259
Mailing Address - Fax:
Practice Address - Street 1:621 E CAMPBELL AVE STE 11E
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-2136
Practice Address - Country:US
Practice Address - Phone:408-881-2607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19220225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist