Healthcare Provider Details

I. General information

NPI: 1093986754
Provider Name (Legal Business Name): CHAD R MARQUIS C.P.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2008
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26300 LA ALAMEDA STE 120
MISSION VIEJO CA
92691-6380
US

IV. Provider business mailing address

26300 LA ALAMEDA SUITE 120
MISSION VIEJO CA
92691
US

V. Phone/Fax

Practice location:
  • Phone: 949-272-2237
  • Fax: 949-367-0277
Mailing address:
  • Phone: 949-272-2237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: