Healthcare Provider Details

I. General information

NPI: 1356904577
Provider Name (Legal Business Name): MARSHALL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 04/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3581 PALMER DR STE 202
CAMERON PARK CA
95682-8237
US

IV. Provider business mailing address

PO BOX 45680
SAN FRANCISCO CA
94145-0680
US

V. Phone/Fax

Practice location:
  • Phone: 530-672-7000
  • Fax:
Mailing address:
  • Phone: 530-626-2618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIM SANGUINETTI-WEISHAAR
Title or Position: PROVIDER CREDENTIALING
Credential:
Phone: 530-626-2770