Provider Demographics
NPI:1144372921
Name:SKLAR, MARC BENJAMIN (LAC, DA (RI))
Entity type:Individual
Prefix:MR
First Name:MARC
Middle Name:BENJAMIN
Last Name:SKLAR
Suffix:
Gender:M
Credentials:LAC, DA (RI)
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Mailing Address - Street 1:2820 CAMINO DEL RIO SOUTH
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108
Mailing Address - Country:US
Mailing Address - Phone:858-381-2281
Mailing Address - Fax:619-546-5815
Practice Address - Street 1:2820 CAMINO DEL RIO SOUTH
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108
Practice Address - Country:US
Practice Address - Phone:858-381-2281
Practice Address - Fax:619-546-5815
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA9332171100000X
261Q00000X
CAAC9332171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center