Healthcare Provider Details

I. General information

NPI: 1952063109
Provider Name (Legal Business Name): MARCEL LEROY SALERY FNP-C, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2934 N FRESNO ST
FRESNO CA
93703-1123
US

IV. Provider business mailing address

2338 RICHERT AVE
CLOVIS CA
93611-3919
US

V. Phone/Fax

Practice location:
  • Phone: 559-549-6697
  • Fax:
Mailing address:
  • Phone: 559-708-7191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95016054
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number95016054
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: