Provider Demographics
NPI:1376023895
Name:LAWSON, MARC
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:LAWSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4740 BALBOA ST APT 106
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-2468
Mailing Address - Country:US
Mailing Address - Phone:415-595-0885
Mailing Address - Fax:
Practice Address - Street 1:2 EDGEWOOD CT
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94014-1841
Practice Address - Country:US
Practice Address - Phone:650-994-7110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program