Healthcare Provider Details

I. General information

NPI: 1720617194
Provider Name (Legal Business Name): MARREY RUBY LAXA QUIZON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S STE 400
ORANGE CA
92868-3201
US

IV. Provider business mailing address

2406 W COMMONWEALTH AVE APT 3
FULLERTON CA
92833-2976
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-5413
  • Fax:
Mailing address:
  • Phone: 818-388-4084
  • Fax:

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 StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number183328
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: