Provider Demographics
NPI:1558409722
Name:RATTELY, MARSHALL
Entity Type:Individual
Prefix:MR
First Name:MARSHALL
Middle Name:
Last Name:RATTELY
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:PO BOX 2564
Mailing Address - Street 2:
Mailing Address - City:CRESTLINE
Mailing Address - State:CA
Mailing Address - Zip Code:92325-2564
Mailing Address - Country:US
Mailing Address - Phone:909-338-4600
Mailing Address - Fax:
Practice Address - Street 1:237 W MILL ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-1403
Practice Address - Country:US
Practice Address - Phone:909-388-4133
Practice Address - Fax:909-388-4190
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health