Healthcare Provider Details

I. General information

NPI: 1558113456
Provider Name (Legal Business Name): NATHALIE MEA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 MORENA BLVD STE 2
SAN DIEGO CA
92110-3889
US

IV. Provider business mailing address

1260 MORENA BLVD STE 2
SAN DIEGO CA
92110-3889
US

V. Phone/Fax

Practice location:
  • Phone: 619-398-3261
  • Fax:
Mailing address:
  • Phone: 619-398-3261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: