Healthcare Provider Details

I. General information

NPI: 1336111947
Provider Name (Legal Business Name): SOCORRO MARQUEZ DIAZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 ROSE AVE
SELMA CA
93662-3240
US

IV. Provider business mailing address

1041 ROSE AVE
SELMA CA
93662-3240
US

V. Phone/Fax

Practice location:
  • Phone: 559-856-6090
  • Fax: 559-856-6092
Mailing address:
  • Phone: 559-856-6090
  • Fax: 559-856-6092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number338556
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7120
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: