Provider Demographics
NPI:1205549383
Name:NAGLE, MARCUS
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:
Last Name:NAGLE
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 1:435 W HAWTHORNE ST
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-2016
Mailing Address - Country:US
Mailing Address - Phone:858-610-0423
Mailing Address - Fax:
Practice Address - Street 1:435 W HAWTHORNE ST
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-2016
Practice Address - Country:US
Practice Address - Phone:858-610-0423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1094173171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor