Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 38916 | CA |
NPI | 1003176629 |
---|---|
Provider Name | Dr. Nicole Grace Marquez |
First Address | Torrance, CA 90503-3620 |
Second Address | Garden Grove, CA 92843-2255 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2012 |
Last Update Date | 17/05/2012 |