Healthcare Provider Details

I. General information

NPI: 1902431901
Provider Name (Legal Business Name): MARQUE MEDICAL CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2020
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10391 MAGNOLIA AVE
RIVERSIDE CA
92505-1809
US

IV. Provider business mailing address

2075 SAN JOAQUIN HILLS RD
NEWPORT BEACH CA
92660-6505
US

V. Phone/Fax

Practice location:
  • Phone: 949-760-9222
  • Fax: 949-579-2906
Mailing address:
  • Phone: 949-760-9222
  • Fax: 949-579-2906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: THERESA NGUYEN
Title or Position: DELEGATED OFFICIAL
Credential:
Phone: 949-690-3337