Provider Demographics
NPI:1265950265
Name:MARSHALL, PAIGE LORRAINE (RADT)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:LORRAINE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12235 VOLVER AVE
Mailing Address - Street 2:
Mailing Address - City:FELTON
Mailing Address - State:CA
Mailing Address - Zip Code:95018-8947
Mailing Address - Country:US
Mailing Address - Phone:831-325-5549
Mailing Address - Fax:
Practice Address - Street 1:2901 PARK AVE STE A10
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2831
Practice Address - Country:US
Practice Address - Phone:831-316-3052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-30
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL9864174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist