Provider Demographics
NPI:1801975180
Name:SPENCE, MARCELLA (MS)
Entity type:Individual
Prefix:
First Name:MARCELLA
Middle Name:
Last Name:SPENCE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4096 PIEDMONT AVE
Mailing Address - Street 2:#230
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-5221
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4096 PIEDMONT AVE
Practice Address - Street 2:#230
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5221
Practice Address - Country:US
Practice Address - Phone:510-717-3939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50392390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program