Provider Demographics
NPI:1538462999
Name:MARCOS, JEROME C (NP)
Entity type:Individual
Prefix:MR
First Name:JEROME
Middle Name:C
Last Name:MARCOS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:MR
Other - First Name:JEROME
Other - Middle Name:C
Other - Last Name:MARCOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:907 W LANCASTER BLVD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2305
Mailing Address - Country:US
Mailing Address - Phone:661-723-4829
Mailing Address - Fax:818-975-5069
Practice Address - Street 1:907 W LANCASTER BLVD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2305
Practice Address - Country:US
Practice Address - Phone:661-723-4820
Practice Address - Fax:818-975-5069
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11862363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner