Healthcare Provider Details

I. General information

NPI: 1366844359
Provider Name (Legal Business Name): MARGARET MARQUARDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2014
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E VICTORIA ST
CARSON CA
90747-0001
US

IV. Provider business mailing address

8017 E ROPER ST
LONG BEACH CA
90808-3252
US

V. Phone/Fax

Practice location:
  • Phone: 310-243-3629
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number219366 13369
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: