Provider Demographics
NPI:1497576409
Name:CUMMINGS, MARCELL ISAIAH
Entity type:Individual
Prefix:
First Name:MARCELL
Middle Name:ISAIAH
Last Name:CUMMINGS
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 1:142 N SANTA ROSA ST
Mailing Address - Street 2:
Mailing Address - City:LOS BANOS
Mailing Address - State:CA
Mailing Address - Zip Code:93635-3233
Mailing Address - Country:US
Mailing Address - Phone:209-489-1307
Mailing Address - Fax:
Practice Address - Street 1:250 CHERRY LN
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-4395
Practice Address - Country:US
Practice Address - Phone:209-200-9481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician