Healthcare Provider Details

I. General information

NPI: 1558785956
Provider Name (Legal Business Name): CARLOS MEJIA CSAC I
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2014
Last Update Date: 02/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 E. 3RD ST.
LOS ANGELES CA
90013
US

IV. Provider business mailing address

3002 ALSACE AVE
LOS ANGELES CA
90016-3802
US

V. Phone/Fax

Practice location:
  • Phone: 213-626-6411
  • Fax:
Mailing address:
  • Phone: 213-626-6411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: