1316204274 NPI number — MARCUS WEIGHT ASSIST. TECH. PRO.

Table of content: MARCUS WEIGHT ASSIST. TECH. PRO. (NPI 1316204274)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316204274 NPI number — MARCUS WEIGHT ASSIST. TECH. PRO.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEIGHT
Provider First Name:
MARCUS
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ASSIST. TECH. PRO.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316204274
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 270492
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92198-2492
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-380-6301
Provider Business Mailing Address Fax Number:
800-380-6301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16343 AVENIDA SUAVIDAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92128-3216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-380-6301
Provider Business Practice Location Address Fax Number:
800-380-6301
Provider Enumeration Date:
04/17/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225CA2400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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