Provider Demographics
NPI:1710325816
Name:MARCUS, ALISON MARIAN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:MARIAN
Last Name:MARCUS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:ALISON
Other - Middle Name:MARIAN
Other - Last Name:HULETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:61 WESTBURY ST
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-3654
Mailing Address - Country:US
Mailing Address - Phone:805-551-4499
Mailing Address - Fax:
Practice Address - Street 1:1009 N AVALON BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-4505
Practice Address - Country:US
Practice Address - Phone:310-549-5760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23109363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical