Healthcare Provider Details

I. General information

NPI: 1801941976
Provider Name (Legal Business Name): EUGENE JASO MARQUEZ BS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4024 DURFEE AVE
EL MONTE CA
91732-2510
US

IV. Provider business mailing address

4024 DURFEE AVE
EL MONTE CA
91732-2510
US

V. Phone/Fax

Practice location:
  • Phone: 213-305-3712
  • Fax: 626-455-4608
Mailing address:
  • Phone: 626-471-6535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: