Healthcare Provider Details

I. General information

NPI: 1396110607
Provider Name (Legal Business Name): LOULU MARQUEZ COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2015
Last Update Date: 12/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8135 PAINTER AVE SUITE 200
WHITTIER CA
90602
US

IV. Provider business mailing address

16011 PLACID DR
WHITTIER CA
90604-3950
US

V. Phone/Fax

Practice location:
  • Phone: 562-698-6600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number3289
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: