Healthcare Provider Details

I. General information

NPI: 1316063316
Provider Name (Legal Business Name): CAROL DIANE MEJIA MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2695 S 4TH ST
EL CENTRO CA
92243-6012
US

IV. Provider business mailing address

1046 ROSS AVE
EL CENTRO CA
92243-4370
US

V. Phone/Fax

Practice location:
  • Phone: 760-482-4033
  • Fax:
Mailing address:
  • Phone: 760-353-4224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: