Provider Demographics
NPI:1871286864
Name:HOLDER, MARQUESE DEMORE
Entity type:Individual
Prefix:MR
First Name:MARQUESE
Middle Name:DEMORE
Last Name:HOLDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3107 S GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-3816
Mailing Address - Country:US
Mailing Address - Phone:213-774-8186
Mailing Address - Fax:213-774-1688
Practice Address - Street 1:3107 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-3816
Practice Address - Country:US
Practice Address - Phone:213-744-8186
Practice Address - Fax:213-744-1688
Is Sole Proprietor?:No
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1500820323225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor