Healthcare Provider Details

I. General information

NPI: 1154121093
Provider Name (Legal Business Name): MS. MARSHA LATOYA MCDONALD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2025
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W REDLANDS BLVD STE B
REDLANDS CA
92373-4642
US

IV. Provider business mailing address

501 W REDLANDS BLVD STE B
REDLANDS CA
92373-4642
US

V. Phone/Fax

Practice location:
  • Phone: 909-686-6233
  • Fax:
Mailing address:
  • Phone: 909-686-6233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberPMH01250035
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: