Provider Demographics
NPI:1457602187
Name:IBANEZ MEJIA, NANCY I (MS)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:I
Last Name:IBANEZ MEJIA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 HOWARD AVE STE 727
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-4212
Mailing Address - Country:US
Mailing Address - Phone:650-210-6872
Mailing Address - Fax:
Practice Address - Street 1:1450 CHAPIN AVE
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-4062
Practice Address - Country:US
Practice Address - Phone:650-348-6603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health