Provider Demographics
NPI:1114070992
Name:SHIBLEY, MARIELA G (PSYD)
Entity Type:Individual
Prefix:
First Name:MARIELA
Middle Name:G
Last Name:SHIBLEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3604 4TH AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4165
Mailing Address - Country:US
Mailing Address - Phone:619-307-9346
Mailing Address - Fax:
Practice Address - Street 1:3604 4TH AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4165
Practice Address - Country:US
Practice Address - Phone:619-307-9346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23239103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical