Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | ||
N | 222Z00000X | Podiatrist | ||
Y | 224P00000X | Prosthetist |
NPI | 1093986754 |
---|---|
Provider Name | Mr. Chad R Marquis |
First Address | Mission Viejo, CA 92691 |
Second Address | Mission Viejo, CA 92691-6380 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2008 |
Last Update Date | 17/03/2018 |