Healthcare Provider Details

I. General information

NPI: 1477293132
Provider Name (Legal Business Name): CARISSA SHANTI KLARICH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2195 S VIRGINIA ST RM 43
RENO NV
89502-3415
US

IV. Provider business mailing address

215 BRENHAM AVE
RENO NV
89509-4646
US

V. Phone/Fax

Practice location:
  • Phone: 775-541-6399
  • Fax:
Mailing address:
  • Phone: 775-688-2090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number29220
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: