Provider Demographics
NPI:1962112367
Name:MARQUEZ, CANDIDO MANUEL
Entity type:Individual
Prefix:
First Name:CANDIDO
Middle Name:MANUEL
Last Name:MARQUEZ
Suffix:
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 1:1324 MONTEREY ST
Mailing Address - Street 2:
Mailing Address - City:SOLEDAD
Mailing Address - State:CA
Mailing Address - Zip Code:93960-2922
Mailing Address - Country:US
Mailing Address - Phone:831-525-8101
Mailing Address - Fax:
Practice Address - Street 1:641 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:KING CITY
Practice Address - State:CA
Practice Address - Zip Code:93930-3231
Practice Address - Country:US
Practice Address - Phone:831-525-8181
Practice Address - Fax:831-525-8130
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)