Provider Demographics
NPI:1497080980
Name:NATASHA D. MARSHALL, DPM, PODIATRY CORPORATION
Entity Type:Organization
Organization Name:NATASHA D. MARSHALL, DPM, PODIATRY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:714-990-4422
Mailing Address - Street 1:410 W CENTRAL AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-3014
Mailing Address - Country:US
Mailing Address - Phone:714-990-4422
Mailing Address - Fax:714-990-2855
Practice Address - Street 1:410 W CENTRAL AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3014
Practice Address - Country:US
Practice Address - Phone:714-990-4422
Practice Address - Fax:714-990-2855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-16
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4830213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6346590001Medicare NSC
CADV528AMedicare UPIN
CACP477AMedicare UPIN