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NPI Code Detail

MEDICARE: EVELYN ITZELT DIAZ MARQUINA

MEDICARE: EVELYN ITZELT DIAZ MARQUINA
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
1106S00000XBehavior TechnicianNO

General Provider Information

NPI Number : 1689555849
Entity Type Code : Individual
Provider Name (Legal Business Name) : EVELYN ITZELT DIAZ MARQUINA
Provider Business Mailing Address
First Line : 3966 60TH ST UNIT 57
Second Line :
City : SAN DIEGO
State : CA
Zip : 92115-6502
Country : US
Telephone Number : 619-855-2321
Fax Number :
Provider Business Practice Location Address
First Line : 3966 60TH ST UNIT 57
Second Line :
City : SAN DIEGO
State : CA
Zip : 92115-6502
Country : US
Telephone Number : 619-855-2321
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2025
Last Update Date : 09/11/2025

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Directions to “ EVELYN ITZELT DIAZ MARQUINA ” Practice Location

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