Healthcare Provider Details

I. General information

NPI: 1871602839
Provider Name (Legal Business Name): CYNTHIA YANINA MEJIA P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 SUNNY CREST DR STE 2600
FULLERTON CA
92835-3644
US

IV. Provider business mailing address

14968 OAKBURY DR
LA MIRADA CA
90638-4531
US

V. Phone/Fax

Practice location:
  • Phone: 714-446-5260
  • Fax:
Mailing address:
  • Phone: 818-523-2324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA17479
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: