Provider Demographics
NPI:1750419537
Name:WASHINGTON, MARCUS D (BACHELOR OF SCIENCE)
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:D
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:BACHELOR OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1972 N FAIR OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-1623
Mailing Address - Country:US
Mailing Address - Phone:626-794-3136
Mailing Address - Fax:
Practice Address - Street 1:1972 N FAIR OAKS AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-1623
Practice Address - Country:US
Practice Address - Phone:626-794-3136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator