Provider Demographics
NPI:1356584882
Name:MARQUEZ, JENNA BRE (LVN)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:BRE
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:ARCHIBALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:3373 KEARNY VILLA LANE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123
Mailing Address - Country:US
Mailing Address - Phone:858-336-2278
Mailing Address - Fax:
Practice Address - Street 1:3373 KEARNY VILLA LN
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1911
Practice Address - Country:US
Practice Address - Phone:858-336-2278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA233758314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility