Healthcare Provider Details

I. General information

NPI: 1457528861
Provider Name (Legal Business Name): ROBERT A MEJIA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S UNION AVE
BAKERSFIELD CA
93307-4179
US

IV. Provider business mailing address

PO BOX 1559 1430 TRUXTUN AVENUE 400
BAKERSFIELD CA
93302-1559
US

V. Phone/Fax

Practice location:
  • Phone: 661-397-8775
  • Fax: 661-397-8286
Mailing address:
  • Phone: 661-635-3050
  • Fax: 661-326-1347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS18648
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: