Healthcare Provider Details

I. General information

NPI: 1255983409
Provider Name (Legal Business Name): BLANCA MEJIA PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 07/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

476 E WASHINGTON AVE
EARLIMART CA
93219
US

IV. Provider business mailing address

PO BOX 3408
VISALIA CA
93278-3408
US

V. Phone/Fax

Practice location:
  • Phone: 800-492-4227
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number30927
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: