Provider Demographics
NPI:1699290866
Name:MARQUEZ, ROMAN ANGEL (RADT)
Entity type:Individual
Prefix:MR
First Name:ROMAN
Middle Name:ANGEL
Last Name:MARQUEZ
Suffix:
Gender:M
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9015 MURRAY AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-3617
Mailing Address - Country:US
Mailing Address - Phone:408-665-4908
Mailing Address - Fax:408-842-0383
Practice Address - Street 1:427 PAJARO ST STE 4
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3459
Practice Address - Country:US
Practice Address - Phone:831-424-6665
Practice Address - Fax:831-424-9717
Is Sole Proprietor?:No
Enumeration Date:2017-08-09
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1446451021101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)