Healthcare Provider Details

I. General information

NPI: 1235142613
Provider Name (Legal Business Name): MARIAN BIRDSALL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 LENNON LN STE 203
WALNUT CREEK CA
94598-2483
US

IV. Provider business mailing address

301 LENNON LN STE 203
WALNUT CREEK CA
94598-2483
US

V. Phone/Fax

Practice location:
  • Phone: 925-939-7334
  • Fax: 925-939-7340
Mailing address:
  • Phone: 925-939-7334
  • Fax: 925-939-7340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA55509
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: