Healthcare Provider Details

I. General information

NPI: 1669086773
Provider Name (Legal Business Name): CONNIE MARQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2020
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 W METROPOLITAN DR STE 401
ORANGE CA
92868-3506
US

IV. Provider business mailing address

405 W 5TH ST STE 658
SANTA ANA CA
92701-4599
US

V. Phone/Fax

Practice location:
  • Phone: 714-954-2955
  • Fax:
Mailing address:
  • Phone: 855-625-4657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number136767
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: