Provider Demographics
NPI:1396594917
Name:MARSHALL, VALERIE (MBA GERONTOLOGY)
Entity type:Individual
Prefix:MISS
First Name:VALERIE
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MBA GERONTOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14628 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-3323
Mailing Address - Country:US
Mailing Address - Phone:442-800-5750
Mailing Address - Fax:
Practice Address - Street 1:14628 MAIN ST
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-3323
Practice Address - Country:US
Practice Address - Phone:442-800-5750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6048336740174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist