Healthcare Provider Details

I. General information

NPI: 1780213116
Provider Name (Legal Business Name): GABRIELLE NICOLE MARQUES DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12100 EUCLID ST
GARDEN GROVE CA
92840-3304
US

IV. Provider business mailing address

12100 EUCLID ST
GARDEN GROVE CA
92840-3304
US

V. Phone/Fax

Practice location:
  • Phone: 833-574-2273
  • Fax:
Mailing address:
  • Phone: 833-574-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A22496
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: