Healthcare Provider Details

I. General information

NPI: 1063051209
Provider Name (Legal Business Name): CARMEN MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2020
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 3RD AVE STE B8
CHULA VISTA CA
91910-3990
US

IV. Provider business mailing address

9920 PACIFIC HEIGHTS BLVD SUITE 150
SAN DIEGO CA
92121-4396
US

V. Phone/Fax

Practice location:
  • Phone: 855-223-7123
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: