MEDICARE: MS. BECKY 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	390200000X	Student in an Organized Health Care Education/Training Program
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1528682507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BECKY MARQUEZ

Provider Business Mailing Address
First Line	:	6020 SANTO RD STE B
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92124-1195
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6020 SANTO RD STE B
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92124-1195
Country	:	US
Telephone Number	:	858-737-4674
Fax Number	:

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

Provider Enumeration Date	:	06/04/2020
Last Update Date	:	08/15/2025

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