Basic Information
| Provider Information | |||||||||
| NPI: | 1679914352 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARROQUIN | ||||||||
| FirstName: | YESENIA | ||||||||
| MiddleName: | AMARILYS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4650 W SUNSET BLVD | ||||||||
| Address2: | MS #53 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900276062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3233612350 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3440 MARKET ST | ||||||||
| Address2: | CHOP'S DEPARTMENT OF CHILD AND ADOLESCENT PSYCHIATRY | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155907555 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2013 | ||||||||
| LastUpdateDate: | 03/12/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 103TC2200X | PS018719 | PA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent |
No ID Information.