Healthcare Provider Details

I. General information

NPI: 1881374205
Provider Name (Legal Business Name): LIZBETH GONZALEZ MARQUEZ BHS I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2023
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PARK AVE
MODESTO CA
95354-0556
US

IV. Provider business mailing address

101 PARK AVE
MODESTO CA
95354-0556
US

V. Phone/Fax

Practice location:
  • Phone: 209-558-4595
  • Fax: 209-558-8031
Mailing address:
  • Phone: 209-558-4595
  • Fax: 209-558-8031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: