Healthcare Provider Details

I. General information

NPI: 1316407786
Provider Name (Legal Business Name): IVAN MARQUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 07/10/2022
Certification Date: 07/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 CONSTITUTION BLVD
SALINAS CA
93906-3100
US

IV. Provider business mailing address

122 N 3RD ST
SALINAS CA
93906-3240
US

V. Phone/Fax

Practice location:
  • Phone: 831-755-4124
  • Fax:
Mailing address:
  • Phone: 630-544-4997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number179894
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: