Provider Demographics
NPI:1659784130
Name:MARCUS, TANYA AMBER (PAC)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:AMBER
Last Name:MARCUS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-5810
Mailing Address - Country:US
Mailing Address - Phone:619-551-7400
Mailing Address - Fax:
Practice Address - Street 1:1306 BROADWAY
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-5810
Practice Address - Country:US
Practice Address - Phone:619-551-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant