MEDICARE: MISS ELIZABETH PAULA MARQUEZ DDS

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	122300000X	Dentist	53831	CA

General Provider Information

NPI Number	:	1548326598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ELIZABETH PAULA MARQUEZ DDS

Provider Business Mailing Address
First Line	:	3636 N FIRST ST
Second Line	:	SUITE 152
City	:	FRESNO
State	:	CA
Zip	:	93726-6818
Country	:	US
Telephone Number	:	559-229-4536
Fax Number	:	559-229-6162

Provider Business Practice Location Address
First Line	:	3636 N FIRST ST
Second Line	:	SUITE 152
City	:	FRESNO
State	:	CA
Zip	:	93726-6818
Country	:	US
Telephone Number	:	559-229-4536
Fax Number	:	559-229-6162

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

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	07/08/2007

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