Healthcare Provider Details

I. General information

NPI: 1134724958
Provider Name (Legal Business Name): NAYRA MARES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11650 IBERIA PL STE 130
SAN DIEGO CA
92128-2431
US

IV. Provider business mailing address

619 WHITNEY ST
CHULA VISTA CA
91910-5117
US

V. Phone/Fax

Practice location:
  • Phone: 858-264-5858
  • Fax: 858-649-6012
Mailing address:
  • Phone: 619-565-4144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: