=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255087045
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. ALEXANDRIA MARQUEZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2022
-----------------------------------------------------
Last Update Date | 03/01/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2501 N GREEN VALLEY PKWY STE 101
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89014-2158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-508-5920
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3114 BICCARI AVE
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89044-0541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-738-4303
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MI4057
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------