Healthcare Provider Details

I. General information

NPI: 1891480265
Provider Name (Legal Business Name): ELISABETH MEJIAS CORREA PHARMACY TECHNICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELISABETH MEJIAS PHD

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11716 GURLEY AVE APT 14
DOWNEY CA
90241-4834
US

IV. Provider business mailing address

11716 GURLEY AVE APT 14
DOWNEY CA
90241-4834
US

V. Phone/Fax

Practice location:
  • Phone: 562-650-3179
  • Fax:
Mailing address:
  • Phone: 562-650-3179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: