Individual
MARCUS DANIEL SAMPLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
503 ALCOTT AVE, POMONA, CA 91766-5304
(626) 703-3778
Mailing address
503 ALCOTT AVE, POMONA, CA 91766-5304
(626) 703-3778
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
CA
Other
Enumeration date
01/04/2025
Last updated
01/04/2025
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