Active NPI
Damara Vivian Marshall, AUD
- Audiologist
- Orange, CA
National Provider Identifier
1285200451
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist
- License
- 3609
- Practice address
- 1301 W Providence Ave
Orange, CA 92868-3892 - Phone
- (714) 639-4991
- NPI assigned
- May 28, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist | 231H00000X | 14623 | CA | |
| Audiologist | 231H00000X | 3609 | CA | Primary |
Addresses
Primary practice location
1301 W Providence Ave
Orange, CA 92868-3892
Mailing address
1301 W Providence Ave
Orange, CA 92868-3892
Phone (714) 639-4991
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14623 | CA | MD | Audiologist |
| 3609 | CA | MD | Audiologist |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1622160000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1629072000000",
"number": "1285200451",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1301 W PROVIDENCE AVE",
"city": "ORANGE",
"state": "CA",
"postal_code": "928683892",
"telephone_number": "714-639-4991"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1301 W PROVIDENCE AVE",
"city": "ORANGE",
"state": "CA",
"postal_code": "928683892",
"telephone_number": "714-639-4991"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARSHALL",
"first_name": "DAMARA",
"middle_name": "VIVIAN",
"credential": "AUD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-05-28",
"last_updated": "2021-08-16",
"certification_date": "2021-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Audiologist",
"state": "CA",
"license": "14623",
"primary": false
},
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "CA",
"license": "3609",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orange, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.