Provider Demographics
NPI:1629845862
Name:MARIN, JESUS DAVID
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:DAVID
Last Name:MARIN
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 1:2291 W MARCH LN
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6652
Mailing Address - Country:US
Mailing Address - Phone:510-513-3823
Mailing Address - Fax:
Practice Address - Street 1:5912 BUCKSKIN PL
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-3675
Practice Address - Country:US
Practice Address - Phone:209-561-2786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician