Healthcare Provider Details

I. General information

NPI: 1447924667
Provider Name (Legal Business Name): CHARITY JOY DAZO MEJIA RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHARITY JOY FLORES DAZO

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 KATELLA AVE
LOS ALAMITOS CA
90720-3434
US

IV. Provider business mailing address

864 S CLEMENTINE ST
ANAHEIM CA
92805-4601
US

V. Phone/Fax

Practice location:
  • Phone: 714-333-5670
  • Fax:
Mailing address:
  • Phone: 714-398-0240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-173519
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: