Provider Demographics
NPI:1316204274
Name:WEIGHT, MARCUS (ASSIST TECH PRO)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:
Last Name:WEIGHT
Suffix:
Gender:M
Credentials:ASSIST TECH PRO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 270492
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92198-2492
Mailing Address - Country:US
Mailing Address - Phone:800-380-6301
Mailing Address - Fax:800-380-6301
Practice Address - Street 1:16343 AVENIDA SUAVIDAD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-3216
Practice Address - Country:US
Practice Address - Phone:800-380-6301
Practice Address - Fax:800-380-6301
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-17
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225CA2400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology Practitioner