Provider Demographics
NPI:1790808186
Name:REDDING, MARINA ROSE
Entity Type:Individual
Prefix:MRS
First Name:MARINA
Middle Name:ROSE
Last Name:REDDING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:COLUSA
Mailing Address - State:CA
Mailing Address - Zip Code:95932-2423
Mailing Address - Country:US
Mailing Address - Phone:530-458-3531
Mailing Address - Fax:530-458-3532
Practice Address - Street 1:439 MARKET ST
Practice Address - Street 2:
Practice Address - City:COLUSA
Practice Address - State:CA
Practice Address - Zip Code:95932-2423
Practice Address - Country:US
Practice Address - Phone:530-458-3531
Practice Address - Fax:530-458-3532
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA3846237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA0038460Medicaid
CAZZZ05867ZOtherBLUE SHIELD PROVIDER #