Provider Demographics
NPI:1881565778
Name:MARQUEZ, BRENDA J (DPT)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:J
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17341 ORANGE WAY
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-3932
Mailing Address - Country:US
Mailing Address - Phone:909-232-2661
Mailing Address - Fax:
Practice Address - Street 1:3191 MISSION INN AVE STE B
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-4188
Practice Address - Country:US
Practice Address - Phone:951-684-2874
Practice Address - Fax:951-684-2980
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-15
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT308857225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty