Provider Demographics
NPI:1811776008
Name:RAZUKI, MARVIN
Entity type:Individual
Prefix:
First Name:MARVIN
Middle Name:
Last Name:RAZUKI
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 1:330 S MAGNOLIA AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-5224
Mailing Address - Country:US
Mailing Address - Phone:619-350-0302
Mailing Address - Fax:
Practice Address - Street 1:330 S MAGNOLIA AVE STE 203
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-5224
Practice Address - Country:US
Practice Address - Phone:619-350-0302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center