Provider Demographics
NPI:1538149224
Name:MARQUEZ, SHERI D (MD)
Entity type:Individual
Prefix:
First Name:SHERI
Middle Name:D
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT 9697
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-9697
Mailing Address - Country:US
Mailing Address - Phone:949-721-6520
Mailing Address - Fax:949-721-6120
Practice Address - Street 1:314 S STRATFORD AVE
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5903
Practice Address - Country:US
Practice Address - Phone:805-925-2529
Practice Address - Fax:805-928-4478
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA608412085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A608410Medicaid
CA00A608410Medicaid