Provider Demographics
NPI:1316672496
Name:MARQUEZ, ROAN JOY LIMPIN
Entity type:Individual
Prefix:
First Name:ROAN
Middle Name:JOY LIMPIN
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 CORPORATE WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-6125
Mailing Address - Country:US
Mailing Address - Phone:916-395-5804
Mailing Address - Fax:
Practice Address - Street 1:1122 CORPORATE WAY STE 300
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-6125
Practice Address - Country:US
Practice Address - Phone:916-395-5804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57616225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist