Healthcare Provider Details

I. General information

NPI: 1063916922
Provider Name (Legal Business Name): SYLVIA MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 MAPLE AVE
LOS ANGELES CA
90014-2211
US

IV. Provider business mailing address

631 MAPLE AVE STE C
LOS ANGELES CA
90014-2211
US

V. Phone/Fax

Practice location:
  • Phone: 213-680-6366
  • Fax:
Mailing address:
  • Phone: 213-680-6366
  • Fax: 213-895-6276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: