Provider Demographics
NPI:1275040545
Name:MARSHALL, THERESA (ND)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CLARK CT
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-3073
Mailing Address - Country:US
Mailing Address - Phone:732-693-1042
Mailing Address - Fax:
Practice Address - Street 1:800 W IVY ST STE A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-1771
Practice Address - Country:US
Practice Address - Phone:858-997-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA956175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath