Healthcare Provider Details

I. General information

NPI: 1821708512
Provider Name (Legal Business Name): JULIO MEJIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2022
Last Update Date: 12/02/2022
Certification Date: 12/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8302 ESPRESSO DR STE 100
BAKERSFIELD CA
93312-5688
US

IV. Provider business mailing address

4833 E WASHINGTON AVE
FRESNO CA
93727-3053
US

V. Phone/Fax

Practice location:
  • Phone: 661-771-3351
  • Fax:
Mailing address:
  • Phone: 559-420-2358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number00017421
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: