MEDICARE: MRS. BERNADETTE JOYCE MEJIA M.S., R.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	1081537	CA

General Provider Information

NPI Number	:	1528305158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BERNADETTE JOYCE MEJIA M.S., R.D.

Provider Business Mailing Address
First Line	:	PO BOX 72086
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90002-0086
Country	:	US
Telephone Number	:	818-749-5547
Fax Number	:

Provider Business Practice Location Address
First Line	:	5306 BUCHANAN ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90042-2444
Country	:	US
Telephone Number	:	818-749-5547
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2013
Last Update Date	:	01/16/2013

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