Healthcare Provider Details

I. General information

NPI: 1578228284
Provider Name (Legal Business Name): DIANA ABIGAIL MEJIA NONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 09/02/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 N EL CENTRO AVE
LOS ANGELES CA
90038-3805
US

IV. Provider business mailing address

112 S PALOS VERDES ST
SAN PEDRO CA
90731-2833
US

V. Phone/Fax

Practice location:
  • Phone: 424-382-7348
  • Fax:
Mailing address:
  • Phone: 424-382-7348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: