Provider Demographics
NPI:1275809584
Name:WALSH, MARIETTA ELIZABETH (DO)
Entity type:Individual
Prefix:DR
First Name:MARIETTA
Middle Name:ELIZABETH
Last Name:WALSH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:FRENCH CAMP
Mailing Address - State:CA
Mailing Address - Zip Code:95231-9693
Mailing Address - Country:US
Mailing Address - Phone:209-468-6603
Mailing Address - Fax:209-468-6585
Practice Address - Street 1:500 W HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:FRENCH CAMP
Practice Address - State:CA
Practice Address - Zip Code:95231-9693
Practice Address - Country:US
Practice Address - Phone:209-468-6603
Practice Address - Fax:209-468-6585
Is Sole Proprietor?:No
Enumeration Date:2012-03-30
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADO-05039207T00000X
IL125.057859207T00000X
CAA23971207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery