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General NPI Number Information
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NPI Number | 1316204274
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Entity Type | Individual
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Provider Name | MARCUS WEIGHT ASSIST. TECH. PRO.
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Gender | Male
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Dates
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Enumeration Date | 04/17/2012
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Last Update Date | 04/17/2012
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Provider Practice Location Address
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Address Line | 16343 AVENIDA SUAVIDAD
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City | SAN DIEGO
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State | CA
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Zip | 92128-3216
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Country | US
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Telephone | 800-380-6301
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Fax | 800-380-6301
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Provider Business Mailing Address
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Address Line | PO BOX 270492
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City | SAN DIEGO
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State | CA
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Zip | 92198-2492
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Country | US
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Telephone | 800-380-6301
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Fax | 800-380-6301
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225CA2400X
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Taxonomy Name | Assistive Technology Practitioner Rehabilitation Counselor
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License Number |
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License Number State |
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