Healthcare Provider Details

I. General information

NPI: 1194644583
Provider Name (Legal Business Name): JULISSA J MARQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 W CLINTON AVE
FRESNO CA
93705-4512
US

IV. Provider business mailing address

4767 E LIBERTY AVE
FRESNO CA
93702-3915
US

V. Phone/Fax

Practice location:
  • Phone: 559-396-8177
  • Fax:
Mailing address:
  • Phone: 559-396-8177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1194493049
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: