Healthcare Provider Details

I. General information

NPI: 1760928873
Provider Name (Legal Business Name): MARQUITA FACEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2017
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 TECHNOLOGY CT STE 300
RIVERSIDE CA
92507-2156
US

IV. Provider business mailing address

1872 RUSTRIDGE PL APT 106
CORONA CA
92881-6414
US

V. Phone/Fax

Practice location:
  • Phone: 951-686-8500
  • Fax:
Mailing address:
  • Phone: 951-318-4111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: