Provider Demographics
NPI:1770811812
Name:MARQUEZ, PHAEDRA G (RN)
Entity type:Individual
Prefix:MRS
First Name:PHAEDRA
Middle Name:G
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:PHAEDRA
Other - Middle Name:B
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1691 THE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2203
Mailing Address - Country:US
Mailing Address - Phone:408-495-3619
Mailing Address - Fax:408-287-0405
Practice Address - Street 1:650 N FULTON ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93728-3404
Practice Address - Country:US
Practice Address - Phone:877-855-7526
Practice Address - Fax:559-488-4999
Is Sole Proprietor?:No
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA530375163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse