Provider Demographics
NPI:1386278539
Name:PUERTA MEJIAS, NEYGUIS NATHALYS
Entity type:Individual
Prefix:MRS
First Name:NEYGUIS
Middle Name:NATHALYS
Last Name:PUERTA MEJIAS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:NATHALYS
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2416 CALIFORNIA ST APT A
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-1898
Mailing Address - Country:US
Mailing Address - Phone:773-236-3019
Mailing Address - Fax:
Practice Address - Street 1:3301 E 12TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-3424
Practice Address - Country:US
Practice Address - Phone:510-269-9030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor