Provider Demographics
NPI:1184150559
Name:VAWTER, MARQUIS PHILIP (PHD, MSED)
Entity type:Individual
Prefix:DR
First Name:MARQUIS
Middle Name:PHILIP
Last Name:VAWTER
Suffix:
Gender:M
Credentials:PHD, MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28361 VIA ALFONSE
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-7060
Mailing Address - Country:US
Mailing Address - Phone:949-824-9014
Mailing Address - Fax:949-824-0515
Practice Address - Street 1:101 CITY DRIVE
Practice Address - Street 2:UNIVERSITY OF CALIFORNIA IRVINE MEDICAL CENTER
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:949-824-9014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 16694103T00000X
CAMFC 25914106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist