Healthcare Provider Details

I. General information

NPI: 1457861288
Provider Name (Legal Business Name): MRS. SABRINA MARQUEZ MORENO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SABRINA MARQUEZ

II. Dates (important events)

Enumeration Date: 10/06/2017
Last Update Date: 04/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1461 E COOLEY DR STE 100
COLTON CA
92324
US

IV. Provider business mailing address

27261 LAS RAMBLAS STE 220
MISSION VIEJO CA
92691-6468
US

V. Phone/Fax

Practice location:
  • Phone: 909-835-4800
  • Fax: 909-835-4997
Mailing address:
  • Phone: 909-835-4800
  • Fax: 909-835-4997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number109945
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: