Provider Demographics
NPI:1942793880
Name:LACAP, MARJORIE TAYAG
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:TAYAG
Last Name:LACAP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 SOUTHGATE AVE APT 210
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2264
Mailing Address - Country:US
Mailing Address - Phone:650-534-8569
Mailing Address - Fax:
Practice Address - Street 1:751 CAMINO PLZ # A
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-3401
Practice Address - Country:US
Practice Address - Phone:650-627-8045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician