Healthcare Provider Details

I. General information

NPI: 1669380168
Provider Name (Legal Business Name): AMY JULISSA MARROQUIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 HAGGIN OAKS BLVD STE 202
BAKERSFIELD CA
93311-1333
US

IV. Provider business mailing address

171 POTTER ST
SHAFTER CA
93263-3405
US

V. Phone/Fax

Practice location:
  • Phone: 661-735-3887
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: