Active NPI
Carly Renee Marshalla
- Psychiatry Physician
- Fresno, CA
National Provider Identifier
1942576764
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- A128636
- Practice address
- 1320 E Shaw Ave
Fresno, CA 93710-7919 - Phone
- (559) 221-3314
- NPI assigned
- Mar 26, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | A128636 | CA | Primary |
Addresses
Primary practice location
1320 E Shaw Ave
Fresno, CA 93710-7919
Mailing address
563 W Muncie Ave
Clovis, CA 93619-8352
Phone (559) 885-2121
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A128636 | CA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1332720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656028800000",
"number": "1942576764",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "563 W MUNCIE AVE",
"city": "CLOVIS",
"state": "CA",
"postal_code": "936198352",
"telephone_number": "559-885-2121"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1320 E SHAW AVE",
"city": "FRESNO",
"state": "CA",
"postal_code": "937107919",
"telephone_number": "559-221-3314"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARSHALLA",
"first_name": "CARLY",
"middle_name": "RENEE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-03-26",
"last_updated": "2022-06-24",
"certification_date": "2022-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "A128636",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fresno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.