Healthcare Provider Details

I. General information

NPI: 1396152856
Provider Name (Legal Business Name): JONATHAN MARQUES ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JON MARQUES ATC

II. Dates (important events)

Enumeration Date: 07/16/2014
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3048 TYLER AVE
EL MONTE CA
91731-3399
US

IV. Provider business mailing address

11136 CHANDLER BLVD APT 393
NORTH HOLLYWOOD CA
91601-3294
US

V. Phone/Fax

Practice location:
  • Phone: 626-444-7701
  • Fax:
Mailing address:
  • Phone: 408-836-0167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: