Provider Demographics
NPI:1760453096
Name:CONTRERAS, MARSHALL R (MD)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:R
Last Name:CONTRERAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 DELBON AVE
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-2005
Mailing Address - Country:US
Mailing Address - Phone:209-634-2925
Mailing Address - Fax:209-634-9169
Practice Address - Street 1:880 DELBON AVE
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2005
Practice Address - Country:US
Practice Address - Phone:209-634-2925
Practice Address - Fax:209-634-9169
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC38129207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C381290Medicaid
CA00C381291Medicare PIN
CAA36851Medicare UPIN