Provider Demographics
NPI:1902658792
Name:MARQUEZ, PAUL J
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:MARQUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4965 N WOODROW AVE APT 103
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-1352
Mailing Address - Country:US
Mailing Address - Phone:559-723-3471
Mailing Address - Fax:
Practice Address - Street 1:4965 N WOODROW AVE APT 103
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-1352
Practice Address - Country:US
Practice Address - Phone:559-723-3471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-04
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty