Provider Demographics
NPI:1386932317
Name:MARSH, NICOLE ANN (MD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:ANN
Last Name:MARSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:210 N TUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3807
Mailing Address - Country:US
Mailing Address - Phone:714-347-1010
Mailing Address - Fax:714-647-1245
Practice Address - Street 1:824 N GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-2127
Practice Address - Country:US
Practice Address - Phone:818-500-0523
Practice Address - Fax:818-500-7294
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA122934207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01671836OtherRR PTAN
CACB251236Medicare PIN