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General NPI Number Information
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NPI Number | 1366115925
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Entity Type | Individual
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Provider Name | IRIDIAN RAFAELA MARQUINA
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Gender | Female
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Dates
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Enumeration Date | 07/29/2021
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Last Update Date | 01/28/2026
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Provider Practice Location Address
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Address Line | 3775 VENTURE DR STE M101
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City | DULUTH
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State | GA
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Zip | 30096-5217
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Country | US
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Telephone | 470-610-4222
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Fax |
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Provider Business Mailing Address
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Address Line | 187 GREEN BRIDGE CT
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-9473
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Country | US
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Telephone | 770-771-2743
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | BACB702046
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-26-87291
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License Number State | GA
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