Provider Demographics
NPI:1831802040
Name:ENOS, MARCIA (CHT)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:ENOS
Suffix:
Gender:F
Credentials:CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25112 BOA DR # 1831
Mailing Address - Street 2:
Mailing Address - City:CRESTLINE
Mailing Address - State:CA
Mailing Address - Zip Code:92325-9676
Mailing Address - Country:US
Mailing Address - Phone:909-454-2864
Mailing Address - Fax:
Practice Address - Street 1:25112 BOA DR # 1831
Practice Address - Street 2:
Practice Address - City:CRESTLINE
Practice Address - State:CA
Practice Address - Zip Code:92325-9676
Practice Address - Country:US
Practice Address - Phone:909-300-5665
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 Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach