Provider Demographics
NPI:1093030769
Name:LEMOS, MARILYN L
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:L
Last Name:LEMOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1129
Mailing Address - Street 2:
Mailing Address - City:MENDOCINO
Mailing Address - State:CA
Mailing Address - Zip Code:95460-1129
Mailing Address - Country:US
Mailing Address - Phone:707-937-4202
Mailing Address - Fax:707-937-6003
Practice Address - Street 1:940 UKIAH ST
Practice Address - Street 2:
Practice Address - City:MENDOCINO
Practice Address - State:CA
Practice Address - Zip Code:95460-1129
Practice Address - Country:US
Practice Address - Phone:707-937-4202
Practice Address - Fax:707-937-6003
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0023374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula