Healthcare Provider Details

I. General information

NPI: 1275287922
Provider Name (Legal Business Name): MARLENE CEBALLO MAS, RD, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2022
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2731 SYSTRON DR STE 200
CONCORD CA
94518-1355
US

IV. Provider business mailing address

2731 SYSTRON DR STE 200
CONCORD CA
94518-1355
US

V. Phone/Fax

Practice location:
  • Phone: 925-655-1700
  • Fax:
Mailing address:
  • Phone: 925-646-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-307963
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86016803
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: