MEDICARE: JULIE ELISABETH MARSHALL RDA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	126800000X	Dental Assistant	43246	CA

General Provider Information

NPI Number	:	1437328408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE ELISABETH MARSHALL RDA

Provider Business Mailing Address
First Line	:	6118 SILVA ST
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90713-1930
Country	:	US
Telephone Number	:	562-920-0700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1299 E WARDLOW RD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-4832
Country	:	US
Telephone Number	:	562-426-0423
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2008
Last Update Date	:	02/25/2008

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