Provider Information for 1629198148
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MARSH ROSE M.A.
Sex: Female
NPI: 1629198148
Last Updated: 2020-10-21
Certification Date: 2020-10-21
Certification Date: 2020-10-21
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1629198148 | ||||||||
| Enumeration Date | 2007-03-29 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | P.O. BOX 907 CLOVERDALE, CA 95425-5427 United States Phone: 707-565-7676 | Fax: | ||||||||
| Primary Practice Address | 2655 BENNETT VALLEY ROAD SANTA ROSA, CA 95404 United States Phone: 707-565-7676 | Fax: | ||||||||
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