Healthcare Provider Details

I. General information

NPI: 1740923184
Provider Name (Legal Business Name): JERICK MARQUEZ ASUNCION RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: VERGEL JERICK MARQUEZ ASUNCION

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14850 ROSCOE BLVD
PANORAMA CITY CA
91402-4677
US

IV. Provider business mailing address

14850 ROSCOE BLVD
PANORAMA CITY CA
91402-4677
US

V. Phone/Fax

Practice location:
  • Phone: 818-904-3569
  • Fax: 818-904-3662
Mailing address:
  • Phone: 818-904-3569
  • Fax: 818-904-3662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number818185
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: