MEDICARE: SUSANA MARGOTH MARROQUIN

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	101YM0800X	Mental Health Counselor
2	106H00000X	Marriage & Family Therapist	105624	CA

General Provider Information

NPI Number	:	1649464330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSANA MARGOTH MARROQUIN

Provider Business Mailing Address
First Line	:	1777 N BELLFLOWER BLVD STE 206
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-4020
Country	:	US
Telephone Number	:	562-668-0186
Fax Number	:

Provider Business Practice Location Address
First Line	:	1777 N BELLFLOWER BLVD STE 206
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-4020
Country	:	US
Telephone Number	:	562-668-0186
Fax Number	:

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

Provider Enumeration Date	:	09/05/2007
Last Update Date	:	11/27/2024

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Directions to “ SUSANA MARGOTH MARROQUIN ” Practice Location

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