Healthcare Provider Details

I. General information

NPI: 1467745729
Provider Name (Legal Business Name): DR. LEEANNE MARQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2011
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23276 S POINTE DR STE 108
LAGUNA HILLS CA
92653-1430
US

IV. Provider business mailing address

23276 S POINTE DR STE 108
LAGUNA HILLS CA
92653-1430
US

V. Phone/Fax

Practice location:
  • Phone: 949-613-4629
  • Fax:
Mailing address:
  • Phone: 949-613-4629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY35792
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: