Healthcare Provider Details

I. General information

NPI: 1588046957
Provider Name (Legal Business Name): HENRY RAFAEL MARQUEZ CASTRO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2015
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 N 8TH ST
EL CENTRO CA
92243-2302
US

IV. Provider business mailing address

202 N 8TH ST
EL CENTRO CA
92243-2302
US

V. Phone/Fax

Practice location:
  • Phone: 442-265-1525
  • Fax:
Mailing address:
  • Phone: 442-265-1525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number151359
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: