Provider Demographics
NPI:1699471201
Name:MARQUIS PSYCHOLOGY PC
Entity type:Organization
Organization Name:MARQUIS PSYCHOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARQUIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:619-432-7332
Mailing Address - Street 1:5252 BALBOA AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-6935
Mailing Address - Country:US
Mailing Address - Phone:619-432-7332
Mailing Address - Fax:
Practice Address - Street 1:5252 BALBOA AVE STE 500
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6935
Practice Address - Country:US
Practice Address - Phone:619-432-7332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-06
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1841865144OtherINDIVIDUAL
CA1154757029OtherINDIVIDUAL
CA1225690043OtherINDIVIDUAL