Healthcare Provider Details

I. General information

NPI: 1003375882
Provider Name (Legal Business Name): CHRISTINE A MARQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N COURT ST
VISALIA CA
93291-4918
US

IV. Provider business mailing address

5415 AVENIDA DE LOS ROBLES STE 102
VISALIA CA
93291-5369
US

V. Phone/Fax

Practice location:
  • Phone: 559-627-2046
  • Fax: 844-368-4079
Mailing address:
  • Phone: 818-235-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: