Provider Demographics
NPI:1669142642
Name:MARQUEZ, PAUL ANTHONY (CPHT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ANTHONY
Last Name:MARQUEZ
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11383 MAR EL ST
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-1402
Mailing Address - Country:US
Mailing Address - Phone:951-660-7965
Mailing Address - Fax:
Practice Address - Street 1:511 AMIGOS DR
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-6283
Practice Address - Country:US
Practice Address - Phone:909-793-8259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA144327183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician