Provider Demographics
NPI:1184326167
Name:MARQUEZ, BRISSA DIANNE I
Entity type:Individual
Prefix:
First Name:BRISSA
Middle Name:DIANNE
Last Name:MARQUEZ
Suffix:I
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 1:1659 DRIFTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-4161
Mailing Address - Country:US
Mailing Address - Phone:442-283-6882
Mailing Address - Fax:
Practice Address - Street 1:1659 DRIFTWOOD DR
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4161
Practice Address - Country:US
Practice Address - Phone:442-283-6882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst