MEDICARE: SABRA G MARQUEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator		CA

General Provider Information

NPI Number	:	1366071102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SABRA G MARQUEZ

Provider Business Mailing Address
First Line	:	1660 HOTEL CIR N
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-2807
Country	:	US
Telephone Number	:	619-961-2120
Fax Number	:

Provider Business Practice Location Address
First Line	:	7032 LEMONWOOD LN
Second Line	:
City	:	LEMON GROVE
State	:	CA
Zip	:	91945-2127
Country	:	US
Telephone Number	:	619-977-7627
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2020
Last Update Date	:	04/03/2020

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