Healthcare Provider Details

I. General information

NPI: 1518747252
Provider Name (Legal Business Name): NATALYA MARCUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 N COYOTE DR STE 128
TUCSON AZ
85745-1256
US

IV. Provider business mailing address

2440 N COYOTE DR STE 128
TUCSON AZ
85745-1256
US

V. Phone/Fax

Practice location:
  • Phone: 978-496-0935
  • Fax:
Mailing address:
  • Phone: 978-496-0935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: