Healthcare Provider Details

I. General information

NPI: 1417605700
Provider Name (Legal Business Name): MARQUE MEDICAL CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 04/21/2022
Certification Date: 04/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21771 LAKE FOREST DR STE 109
LAKE FOREST CA
92630-2782
US

IV. Provider business mailing address

2075 SAN JOAQUIN HILLS RD
NEWPORT BEACH CA
92660-6505
US

V. Phone/Fax

Practice location:
  • Phone: 714-707-6499
  • Fax:
Mailing address:
  • Phone: 714-707-6499
  • Fax: 949-629-3509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALISA JONES
Title or Position: DIRECTOR, RCM
Credential:
Phone: 949-529-8714