Provider Demographics
NPI:1407175300
Name:SIDI-ALI-MEBAREK, BAYA LEYLA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BAYA
Middle Name:LEYLA
Last Name:SIDI-ALI-MEBAREK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:BAYA
Other - Middle Name:LEYLA
Other - Last Name:MEBAREK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 13102
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92039-3102
Mailing Address - Country:US
Mailing Address - Phone:858-337-9884
Mailing Address - Fax:858-755-3042
Practice Address - Street 1:11772 SORRENTO VALLEY RD
Practice Address - Street 2:SUITE 157
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1015
Practice Address - Country:US
Practice Address - Phone:858-337-9884
Practice Address - Fax:858-776-6168
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48379106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty