Provider Demographics
NPI:1629895701
Name:CARVAJAL MEJIA, MELVA YURINA (CNM, WHNP)
Entity type:Individual
Prefix:
First Name:MELVA
Middle Name:YURINA
Last Name:CARVAJAL MEJIA
Suffix:
Gender:F
Credentials:CNM, WHNP
Other - Prefix:
Other - First Name:MELVA
Other - Middle Name:YURINA
Other - Last Name:CARVAJAL GOMEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:141 N SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-1706
Mailing Address - Country:US
Mailing Address - Phone:415-734-6410
Mailing Address - Fax:
Practice Address - Street 1:250 BON AIR RD
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-1702
Practice Address - Country:US
Practice Address - Phone:415-925-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA236470367A00000X
CA95031216363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health