Provider Demographics
NPI:1871878504
Name:MARQUEZ, DENA Z (MOTR/L, PAM, HTC)
Entity type:Individual
Prefix:
First Name:DENA
Middle Name:Z
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:MOTR/L, PAM, HTC
Other - Prefix:
Other - First Name:DENA
Other - Middle Name:
Other - Last Name:TAHMASEB ZAMANIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2070 CEDAR GLEN DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-7839
Mailing Address - Country:US
Mailing Address - Phone:949-419-5500
Mailing Address - Fax:
Practice Address - Street 1:2815 S MAIN ST STE 205
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-2533
Practice Address - Country:US
Practice Address - Phone:951-475-1307
Practice Address - Fax:951-475-1308
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11673225XH1200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA129439Medicare PIN
CACA129442Medicare PIN
CACA129440Medicare PIN
CACA129441Medicare PIN
CACA129441Medicare PIN