1396033056 NPI number — GLADYS MARIA MARROQUIN ASW34610

Table of content: GLADYS MARIA MARROQUIN ASW34610 (NPI 1396033056)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396033056 NPI number — GLADYS MARIA MARROQUIN ASW34610

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARROQUIN
Provider First Name:
GLADYS
Provider Middle Name:
MARIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ASW34610
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396033056
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
160 E VIRGINIA ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95112-5857
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-918-2618
Provider Business Mailing Address Fax Number:
408-579-6143

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
160 E VIRGINIA ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95112-5857
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-918-2618
Provider Business Practice Location Address Fax Number:
408-579-6145
Provider Enumeration Date:
07/15/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 34610 . This is a "ASW" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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