MEDICARE: MARQUES SPENCER

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
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1669161691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARQUES SPENCER

Provider Business Mailing Address
First Line	:	2708 PIANTINO CIR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-4736
Country	:	US
Telephone Number	:	951-497-1389
Fax Number	:

Provider Business Practice Location Address
First Line	:	1625 NEWTON AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92113-1012
Country	:	US
Telephone Number	:	951-497-1389
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2023
Last Update Date	:	05/04/2023

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Directions to “ MARQUES SPENCER ” Practice Location

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