Healthcare Provider Details

I. General information

NPI: 1417779539
Provider Name (Legal Business Name): PEDRO A MEJIA SUM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 09/13/2025
Certification Date: 09/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 S 7TH AVE
LA PUENTE CA
91746-3211
US

IV. Provider business mailing address

10 W BAY STATE ST UNIT 393
ALHAMBRA CA
91802-2816
US

V. Phone/Fax

Practice location:
  • Phone: 626-961-8971
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number125963
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: