Individual provider Active NPI

Michael Marshall, APRN, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Ontario, CA
National Provider Identifier
1245563543
Registry record updated Feb 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
95028122 Issued in CA
Practice address
3200 E Guasti Rd
Ontario, CA 91761-8660
Phone
(909) 755-6610
Fax
(909) 385-3335
NPI assigned
Sep 17, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 95028122 CA Primary
Registered Nurse 163W00000X 679231 CA

Addresses

Primary practice location

3200 E Guasti Rd
Ontario, CA 91761-8660

Mailing address

3200 E Guasti Rd
Ontario, CA 91761-8660
Phone (909) 755-6610

Other practice location 1

14677 Merrill Ave
Fontana, CA 92335-4219
Phone (951) 643-2340

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241017001130 CA Practitioner - Nurse Practitioner 8729510565 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
679231CAMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Marshall Advanced Nursing Practice PC Psychiatric/Mental Health CurrentSince Aug 4, 2024 Accepting new patients
Grow Healthcare Group PC Psychiatric/Mental Health CurrentSince Aug 11, 2024 Accepting new patients
Retro Analysis, Inc. Registered Nurse PastSince Dec 1, 2023 Accepting new patients
Exodus Recovery, Inc. Past Accepting new patients
Exodus Recovery, Inc. Past Accepting new patients
Alondra Loya PastSince Jun 15, 2025 Accepting new patients

Locations

710 N Euclid St
Ste 208
Anaheim, CA 92801
Phone (714) 484-4900

3200 E Guasti Rd
Ontario, CA 91761
Phone (909) 240-2565

99 Almaden Blvd
Ste 600
San Jose, CA 95113
Phone (408) 402-4385

66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1253145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771891200000",
    "number": "1245563543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 E GUASTI RD",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917618660",
            "telephone_number": "909-755-6610",
            "fax_number": "909-385-3335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 E GUASTI RD",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917618660",
            "telephone_number": "909-755-6610",
            "fax_number": "909-385-3335"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14677 Merrill Ave",
            "address_purpose": "LOCATION",
            "city": "Fontana",
            "state": "CA",
            "postal_code": "923354219",
            "country_code": "US",
            "telephone_number": "951-643-2340",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARSHALL",
        "first_name": "MICHAEL",
        "credential": "APRN, PMHNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-09-17",
        "last_updated": "2026-02-24",
        "certification_date": "2026-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95028122",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "679231",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ontario, CA

Sources for this page

Verify at the official NPI Registry.