Provider Demographics
NPI:1992211478
Name:MARQUEZ, MARISSA MANIPUD
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:MANIPUD
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:ABAD
Other - Last Name:MANIPUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1508 STANISLAUS DR
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-1471
Mailing Address - Country:US
Mailing Address - Phone:619-869-7734
Mailing Address - Fax:858-637-5599
Practice Address - Street 1:19005 WILEYS WELL RD
Practice Address - Street 2:
Practice Address - City:BLYTHE
Practice Address - State:CA
Practice Address - Zip Code:92225-2287
Practice Address - Country:US
Practice Address - Phone:760-921-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95008125363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily