Provider Demographics
NPI:1982338414
Name:MARCOTTE, MARC (GCFP,LMTPDTR,ICAK)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:MARCOTTE
Suffix:
Gender:M
Credentials:GCFP,LMTPDTR,ICAK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 18TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-2151
Mailing Address - Country:US
Mailing Address - Phone:650-387-6697
Mailing Address - Fax:
Practice Address - Street 1:2680 BAYSHORE PKWY STE 318
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043-1020
Practice Address - Country:US
Practice Address - Phone:650-387-6697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60909225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist