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General NPI Number Information
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NPI Number | 1861580698
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Entity Type | Individual
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Provider Name | ANN ELLEN MARSHALL PH.D.
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Gender | Female
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 07/05/2017
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Provider Practice Location Address
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Address Line | 16935 W BERNARDO DR STE 110
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City | SAN DIEGO
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State | CA
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Zip | 92127-1635
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Country | US
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Telephone | 858-674-4601
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Fax |
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Provider Business Mailing Address
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Address Line | 16935 W BERNARDO DR SUITE 110
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City | SAN DIEGO
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State | CA
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Zip | 92127-1634
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Country | US
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Telephone | 858-674-4601
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Fax | 858-672-3577
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY9292
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License Number State | CA
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