Healthcare Provider Details

I. General information

NPI: 1902760507
Provider Name (Legal Business Name): ANNA LUISA MARROQUIN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N BRENT ST STE 301
VENTURA CA
93003-2836
US

IV. Provider business mailing address

5443 RALSTON ST UNIT 104
VENTURA CA
93003-6164
US

V. Phone/Fax

Practice location:
  • Phone: 805-653-0101
  • Fax:
Mailing address:
  • Phone: 805-824-9639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number67517
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: