Healthcare Provider Details

I. General information

NPI: 1740708999
Provider Name (Legal Business Name): CEASAR MEJIA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2017
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 S CENTRAL AVE
LOS ANGELES CA
90013-1724
US

IV. Provider business mailing address

573 FRASER AVE
LOS ANGELES CA
90022-1945
US

V. Phone/Fax

Practice location:
  • Phone: 213-675-6131
  • Fax:
Mailing address:
  • Phone: 213-235-8732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number78332
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number100733
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: