Healthcare Provider Details

I. General information

NPI: 1376490664
Provider Name (Legal Business Name): MRS. MARBELY NAYELY MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2026
Last Update Date: 03/14/2026
Certification Date: 03/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 PORTVIEW DR
BAY POINT CA
94565-1333
US

IV. Provider business mailing address

47 PORTVIEW DR
BAY POINT CA
94565-1333
US

V. Phone/Fax

Practice location:
  • Phone: 341-465-0374
  • Fax:
Mailing address:
  • Phone: 341-465-0374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberL10109
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: