Provider Demographics
NPI:1972627412
Name:MARQUEZ, ROSA AMANDA (BA)
Entity Type:Individual
Prefix:MS
First Name:ROSA
Middle Name:AMANDA
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 ARLINGTON AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90018-1336
Mailing Address - Country:US
Mailing Address - Phone:323-737-3900
Mailing Address - Fax:323-737-3993
Practice Address - Street 1:2116 ARLINGTON AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-1336
Practice Address - Country:US
Practice Address - Phone:323-737-3900
Practice Address - Fax:323-737-3993
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner