Healthcare Provider Details

I. General information

NPI: 1598523235
Provider Name (Legal Business Name): JESUS MARQUEZ NAVARRO ATC, PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6770 N WEST AVE
FRESNO CA
93711-1399
US

IV. Provider business mailing address

546 S SISKIYOU AVE
KERMAN CA
93630-9347
US

V. Phone/Fax

Practice location:
  • Phone: 559-713-6806
  • Fax: 559-713-6809
Mailing address:
  • Phone: 559-355-0497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number307648
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000051286
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: