Healthcare Provider Details

I. General information

NPI: 1497686505
Provider Name (Legal Business Name): JULIO MARQUEZ PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 CALLAN AVE
SAN LEANDRO CA
94577-4643
US

IV. Provider business mailing address

15458 HERON DR
SAN LEANDRO CA
94579-2731
US

V. Phone/Fax

Practice location:
  • Phone: 341-258-2050
  • Fax:
Mailing address:
  • Phone: 510-584-1591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number003104
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: