Provider Demographics
NPI:1932244050
Name:MARQUEZ, GRACE MARIE (CFA)
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:MARIE
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1250 LEON WAY #1
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914
Mailing Address - Country:US
Mailing Address - Phone:815-401-6675
Mailing Address - Fax:520-908-8796
Practice Address - Street 1:7106 DOOLEY DR.
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85746-2552
Practice Address - Country:US
Practice Address - Phone:815-401-6675
Practice Address - Fax:520-908-8796
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical