Healthcare Provider Details

I. General information

NPI: 1881565778
Provider Name (Legal Business Name): BRENDA J MARQUEZ DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3191 MISSION INN AVE STE B
RIVERSIDE CA
92507-4188
US

IV. Provider business mailing address

17341 ORANGE WAY
FONTANA CA
92335-3932
US

V. Phone/Fax

Practice location:
  • Phone: 951-684-2874
  • Fax: 951-684-2980
Mailing address:
  • Phone: 909-232-2661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT308857
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: