Healthcare Provider Details

I. General information

NPI: 1184453052
Provider Name (Legal Business Name): MARSHALL ADVANCED NURSING PRACTICE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2024
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 E GUASTI RD
ONTARIO CA
91761-8660
US

IV. Provider business mailing address

3200 E GUASTI RD
ONTARIO CA
91761-8660
US

V. Phone/Fax

Practice location:
  • Phone: 909-755-6610
  • Fax: 909-385-3335
Mailing address:
  • Phone: 909-755-6610
  • Fax: 909-385-3335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL MARSHALL
Title or Position: MANAGER
Credential: PMHNP
Phone: 909-755-6610