Active NPI
Brenda Ann Marshall, MD
- General Practice Physician
- San Diego, CA
National Provider Identifier
1407979842
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- G75014
- Practice address
- 11622 El Camino Real Ste 100
San Diego, CA 92130-2051 - Phone
- (858) 663-7699
- Fax
- (858) 764-2405
- NPI assigned
- Apr 9, 2007
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | G75014 | CA | |
| Adult Medicine Physician | 207QA0505X | G75014 | CA | |
| General Practice Physician | 208D00000X | G75014 | CA | Primary |
Addresses
Primary practice location
11622 El Camino Real Ste 100
San Diego, CA 92130-2051
Mailing address
4210 Federman LN
San Diego, CA 92130-2113
Phone (858) 663-7699
Other names 1
- Brenda Marshall
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Dec 5, 2017 through Dec 5, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G75014 | CA | MD | Adult Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176076800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1574380800000",
"number": "1407979842",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4210 FEDERMAN LN",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921302113",
"telephone_number": "858-663-7699",
"fax_number": "858-764-2405"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11622 EL CAMINO REAL STE 100",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921302051",
"telephone_number": "858-663-7699",
"fax_number": "858-764-2405"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARSHALL",
"first_name": "BRENDA",
"middle_name": "ANN",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-09",
"last_updated": "2019-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "G75014",
"primary": false
},
{
"code": "207QA0505X",
"taxonomy_group": "",
"desc": "Family Medicine, Adult Medicine",
"state": "CA",
"license": "G75014",
"primary": false
},
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "CA",
"license": "G75014",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "BRENDA",
"last_name": "MARSHALL",
"credential": "MD",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.