Healthcare Provider Details

I. General information

NPI: 1962119313
Provider Name (Legal Business Name): LESLY MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2022
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 N MARIPOSA AVE # 329 1/2
LOS ANGELES CA
90004-4403
US

IV. Provider business mailing address

329 N MARIPOSA AVE # 329 1/2
LOS ANGELES CA
90004-4403
US

V. Phone/Fax

Practice location:
  • Phone: 323-376-0118
  • Fax:
Mailing address:
  • Phone: 323-376-0118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: