Healthcare Provider Details

I. General information

NPI: 1467373084
Provider Name (Legal Business Name): MAREAS YOUTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 BONNEY RD STE 105
VIRGINIA BEACH VA
23452-1765
US

IV. Provider business mailing address

4020 BONNEY RD STE 105
VIRGINIA BEACH VA
23452-1765
US

V. Phone/Fax

Practice location:
  • Phone: 434-849-4295
  • Fax:
Mailing address:
  • Phone: 434-849-4295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIANA HERRERA
Title or Position: NP
Credential: NP
Phone: 434-849-4295