Provider Demographics
NPI:1740676345
Name:MARQUEZ, FELCYNTH MAY DESTURA (NP, CNS, RN)
Entity type:Individual
Prefix:
First Name:FELCYNTH MAY
Middle Name:DESTURA
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:NP, CNS, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 CRESTMOOR CIR
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-1514
Mailing Address - Country:US
Mailing Address - Phone:650-219-3726
Mailing Address - Fax:
Practice Address - Street 1:170 CRESTMOOR CIR
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-1514
Practice Address - Country:US
Practice Address - Phone:650-219-3726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001479363L00000X
CA4047364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist