Healthcare Provider Details

I. General information

NPI: 1417282120
Provider Name (Legal Business Name): IMELDA MEJIA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2009
Last Update Date: 08/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1933 S BROADWAY FLOOR 6
LOS ANGELES CA
90007
US

IV. Provider business mailing address

1933 S BROADWAY 6TH FLOOR
LOS ANGELES CA
90007-4501
US

V. Phone/Fax

Practice location:
  • Phone: 213-763-3164
  • Fax: 213-742-7011
Mailing address:
  • Phone: 213-763-3164
  • Fax: 213-742-7011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW81629
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: