Provider Demographics
NPI:1003149055
Name:SHEARER, MARC ALAN
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:ALAN
Last Name:SHEARER
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 1:4811 MANSFIELD ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-1979
Mailing Address - Country:US
Mailing Address - Phone:619-370-8537
Mailing Address - Fax:
Practice Address - Street 1:4811 MANSFIELD ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-1979
Practice Address - Country:US
Practice Address - Phone:619-370-8537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist