Provider Demographics
NPI:1386788933
Name:MEES, MARY JANE (LAC DAOM)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:JANE
Last Name:MEES
Suffix:
Gender:F
Credentials:LAC DAOM
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 757
Mailing Address - Street 2:
Mailing Address - City:AVILA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93424-0757
Mailing Address - Country:US
Mailing Address - Phone:805-705-1792
Mailing Address - Fax:805-456-0456
Practice Address - Street 1:6639A BAY LAUREL PL
Practice Address - Street 2:
Practice Address - City:AVILA BEACH
Practice Address - State:CA
Practice Address - Zip Code:93424-3504
Practice Address - Country:US
Practice Address - Phone:805-705-1792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8417171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist