Healthcare Provider Details

I. General information

NPI: 1982460424
Provider Name (Legal Business Name): VICKY MARQUEZ AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2024
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11500 BROOKSHIRE AVE
DOWNEY CA
90241-4917
US

IV. Provider business mailing address

1119 NEATHERLY CIR
CORONA CA
92878-3640
US

V. Phone/Fax

Practice location:
  • Phone: 562-904-5000
  • Fax: 562-904-5140
Mailing address:
  • Phone: 562-413-0531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95028684
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: