Basic Information
| Provider Information | |||||||||
| NPI: | 1790832459 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCDONALD | ||||||||
| FirstName: | MARCIA | ||||||||
| MiddleName: | STRICKLAND | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 259 MONTECITO AVE | ||||||||
| Address2: | |||||||||
| City: | SHELL BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934491922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057733117 | ||||||||
| FaxNumber: | 8054616061 | ||||||||
| Practice Location | |||||||||
| Address1: | 2178 JOHNSON AVE | ||||||||
| Address2: | |||||||||
| City: | SAN LUIS OBISPO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934014535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054616060 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 20A7302 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.