Provider Demographics
NPI:1689555849
Name:DIAZ MARQUINA, EVELYN ITZELT
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:ITZELT
Last Name:DIAZ MARQUINA
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 1:3966 60TH ST UNIT 57
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-6502
Mailing Address - Country:US
Mailing Address - Phone:619-855-2321
Mailing Address - Fax:
Practice Address - Street 1:3966 60TH ST UNIT 57
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-6502
Practice Address - Country:US
Practice Address - Phone:619-855-2321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NO106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician