Provider Demographics
NPI:1326009820
Name:MARSHALL, EVA TERESA (MD)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:TERESA
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 496084
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-6084
Mailing Address - Country:US
Mailing Address - Phone:707-445-5900
Mailing Address - Fax:707-445-2686
Practice Address - Street 1:3020 H ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-4410
Practice Address - Country:US
Practice Address - Phone:707-445-5900
Practice Address - Fax:707-445-2686
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63543207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A635430Medicaid
CA00A635431Medicare ID - Type Unspecified
CA00A635430Medicaid