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NPI Code Detail

MEDICARE: MARCUS I TUCKER

MEDICARE: MARCUS I TUCKER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1487585287
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARCUS I TUCKER
Provider Business Mailing Address
First Line : 1926 BEVERLY BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90057-2402
Country : US
Telephone Number : 213-353-1140
Fax Number : 213-353-1151
Provider Business Practice Location Address
First Line : 1926 BEVERLY BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90057-2402
Country : US
Telephone Number : 213-353-1140
Fax Number : 213-353-1151
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2026
Last Update Date : 05/28/2026

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Directions to “ MARCUS I TUCKER ” Practice Location

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