Provider Demographics
NPI:1104706407
Name:MARQUEZ, ISAGANI IGNACIO JR
Entity type:Individual
Prefix:MR
First Name:ISAGANI
Middle Name:IGNACIO
Last Name:MARQUEZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6615 CANTER COVE CT
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-3722
Mailing Address - Country:US
Mailing Address - Phone:909-255-5348
Mailing Address - Fax:
Practice Address - Street 1:6615 CANTER COVE CT
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-3722
Practice Address - Country:US
Practice Address - Phone:909-255-5348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF11240448363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily