MEDICARE: FERNANDO 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	101YA0400X	Addiction (Substance Use Disorder) Counselor	200374	CA

General Provider Information

NPI Number	:	1619171303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FERNANDO MARQUEZ

Provider Business Mailing Address
First Line	:	2429 FENTON ST
Second Line	:	SUTIE A
City	:	CHULA VISTA
State	:	CA
Zip	:	91914-3517
Country	:	US
Telephone Number	:	619-482-9300
Fax Number	:

Provider Business Practice Location Address
First Line	:	2429 FENTON ST
Second Line	:	SUTIE A
City	:	CHULA VISTA
State	:	CA
Zip	:	91914-3517
Country	:	US
Telephone Number	:	619-482-9300
Fax Number	:

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

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	07/08/2007

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