Healthcare Provider Details

I. General information

NPI: 1962322297
Provider Name (Legal Business Name): KATE ELIANNA MARSHALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 SPRING ST STE 104
LA MESA CA
91942-0272
US

IV. Provider business mailing address

5345 TOSCANA WAY APT 5111
SAN DIEGO CA
92122-5315
US

V. Phone/Fax

Practice location:
  • Phone: 619-782-0700
  • Fax:
Mailing address:
  • Phone: 314-348-3716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: