Healthcare Provider Details

I. General information

NPI: 1740676345
Provider Name (Legal Business Name): FELCYNTH MAY DESTURA MARQUEZ NP, CNS, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 04/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 CRESTMOOR CIR
PACIFICA CA
94044-1514
US

IV. Provider business mailing address

170 CRESTMOOR CIR
PACIFICA CA
94044-1514
US

V. Phone/Fax

Practice location:
  • Phone: 650-219-3726
  • Fax:
Mailing address:
  • Phone: 650-219-3726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95001479
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number4047
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: