Healthcare Provider Details

I. General information

NPI: 1962564708
Provider Name (Legal Business Name): EDUARDO JOSE MARCUS PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 09/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 CONSTITUTION BLVD BLDG 151 # 202
SALINAS CA
93906-3100
US

IV. Provider business mailing address

1110 LA TERRACE CIR
SAN JOSE CA
95123-5351
US

V. Phone/Fax

Practice location:
  • Phone: 831-769-8640
  • Fax: 831-769-8640
Mailing address:
  • Phone: 408-323-9810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA20186
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: