Healthcare Provider Details

I. General information

NPI: 1295860955
Provider Name (Legal Business Name): JUAN CARLOS MEJIA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 W OLYMPIC BLVD STE 600
LOS ANGELES CA
90015
US

IV. Provider business mailing address

1625 W OLYMPIC BLVD STE 600
LOS ANGELES CA
90015-3809
US

V. Phone/Fax

Practice location:
  • Phone: 323-000-2404
  • Fax: 213-947-4565
Mailing address:
  • Phone: 323-999-2404
  • Fax: 213-947-4565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW75500
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: