Provider Demographics
NPI:1245568021
Name:MARCUS, JACOB DAVID (EMT-1)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:DAVID
Last Name:MARCUS
Suffix:
Gender:M
Credentials:EMT-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2135 E VALLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-2744
Mailing Address - Country:US
Mailing Address - Phone:818-970-5120
Mailing Address - Fax:
Practice Address - Street 1:2135 E VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027-2744
Practice Address - Country:US
Practice Address - Phone:818-970-5120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-06
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54935146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic