Provider Demographics
NPI:1811100530
Name:DAGUIO, AMY LYNN MARQUEZ (MD)
Entity type:Individual
Prefix:DR
First Name:AMY LYNN
Middle Name:MARQUEZ
Last Name:DAGUIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5256 MISSION BLVD
Mailing Address - Street 2:
Mailing Address - City:JURUPA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92509-4624
Mailing Address - Country:US
Mailing Address - Phone:951-955-0840
Mailing Address - Fax:951-275-8762
Practice Address - Street 1:5256 MISSION BLVD
Practice Address - Street 2:
Practice Address - City:JURUPA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92509-4624
Practice Address - Country:US
Practice Address - Phone:951-955-0840
Practice Address - Fax:951-275-8762
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA100543207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0A1005430OtherBLUE SHEILD OF CALIFORNIA
CA0A1005430Medicare PIN