Provider Demographics
NPI:1184385486
Name:MARKS, GINA ISABELL (LAC)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:ISABELL
Last Name:MARKS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-5408
Mailing Address - Country:US
Mailing Address - Phone:925-817-9429
Mailing Address - Fax:
Practice Address - Street 1:2255 MORELLO AVE STE 221
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-1879
Practice Address - Country:US
Practice Address - Phone:925-281-3888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-07
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19294171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist