Healthcare Provider Details

I. General information

NPI: 1790954865
Provider Name (Legal Business Name): NAOMI ALESSA MARR WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 SANTA MARIA WAY
SANTA MARIA CA
93455-2118
US

IV. Provider business mailing address

791 PRICE ST # 170
PISMO BEACH CA
93449-2529
US

V. Phone/Fax

Practice location:
  • Phone: 805-934-5400
  • Fax: 805-938-9207
Mailing address:
  • Phone: 805-387-8651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberNP 17941
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: