Basic Information
| Provider Information | |||||||||
| NPI: | 1972627412 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARQUEZ | ||||||||
| FirstName: | ROSA | ||||||||
| MiddleName: | AMANDA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | BA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2116 ARLINGTON AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900181336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237373900 | ||||||||
| FaxNumber: | 3237373993 | ||||||||
| Practice Location | |||||||||
| Address1: | 2116 ARLINGTON AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900181336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237373900 | ||||||||
| FaxNumber: | 3237373993 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.