Healthcare Provider Details

I. General information

NPI: 1497080980
Provider Name (Legal Business Name): NATASHA D. MARSHALL, DPM, PODIATRY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2009
Last Update Date: 07/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W CENTRAL AVE SUITE 204
BREA CA
92821-3014
US

IV. Provider business mailing address

410 W CENTRAL AVE SUITE 204
BREA CA
92821-3014
US

V. Phone/Fax

Practice location:
  • Phone: 714-990-4422
  • Fax: 714-990-2855
Mailing address:
  • Phone: 714-990-4422
  • Fax: 714-990-2855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberE4830
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4830
License Number StateCA

VIII. Authorized Official

Name: DR. NATASHA MARSHALL
Title or Position: PRESIDENT/CEO
Credential: DPM
Phone: 714-990-4422