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General NPI Number Information
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NPI Number | 1548421175
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Entity Type | Individual
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Provider Name | VINCENT J. MARQUEZ LCSW
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Gender | Male
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Dates
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Enumeration Date | 06/17/2008
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Last Update Date | 07/10/2016
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Provider Practice Location Address
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Address Line | 2247 SAN DIEGO AVE STE 136 10650 SCRIPPS CANYON RD, STE 131, SAN DIEGO, CA 92131
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City | SAN DIEGO
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State | CA
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Zip | 92110-2943
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Country | US
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Telephone | 773-330-2144
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Fax |
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Provider Business Mailing Address
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Address Line | 2247 SAN DIEGO AVE STE 136
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City | SAN DIEGO
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State | CA
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Zip | 92110-2943
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Country | US
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Telephone | 773-330-2144
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 28128
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License Number State | CA
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