Healthcare Provider Details

I. General information

NPI: 1376406876
Provider Name (Legal Business Name): MARCKEL AMIR HOBSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 CONCOURS STE 4102
ONTARIO CA
91764-6564
US

IV. Provider business mailing address

15450 NISQUALLI RD
VICTORVILLE CA
92395-8535
US

V. Phone/Fax

Practice location:
  • Phone: 909-240-1764
  • Fax:
Mailing address:
  • Phone: 909-240-1764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: