Healthcare Provider Details

I. General information

NPI: 1992387468
Provider Name (Legal Business Name): MARIELA NEVAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2021
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 PORTRERO AVE
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

1001 PORTRERO AVE
SAN FRANCISCO CA
94110-3518
US

V. Phone/Fax

Practice location:
  • Phone: 415-206-4069
  • Fax:
Mailing address:
  • Phone: 415-206-4069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA197844
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: