Provider Demographics
NPI:1831755123
Name:DIEZ-QUINTON, MARIE
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:DIEZ-QUINTON
Suffix:
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 1:2 UPPER RAGSDALE DR STE D200
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-7839
Mailing Address - Country:US
Mailing Address - Phone:831-649-7220
Mailing Address - Fax:
Practice Address - Street 1:2 UPPER RAGSDALE DR STE D200
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-7839
Practice Address - Country:US
Practice Address - Phone:831-649-7220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011727363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95011727OtherBOARD OF REGISTERED NURSES - NP LICENSE NUMBER