Healthcare Provider Details

I. General information

NPI: 1750601993
Provider Name (Legal Business Name): RIA HERMOSILLA MEJIA M.ED.,OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 08/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 W BONITA AVE
CLAREMONT CA
91711
US

IV. Provider business mailing address

6588 EUCALYPTUS AVE
CHINO CA
91710-0101
US

V. Phone/Fax

Practice location:
  • Phone: 323-241-2019
  • Fax:
Mailing address:
  • Phone: 323-241-2019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number13878
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number113232
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number14634
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: