Healthcare Provider Details

I. General information

NPI: 1720119878
Provider Name (Legal Business Name): PATRICIA DEL CARMEN MEJIA MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 12/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 GRIFFIN AVE
LOS ANGELES CA
90031-3312
US

IV. Provider business mailing address

7825 WHITE OAK AVE
RESEDA CA
91335-2223
US

V. Phone/Fax

Practice location:
  • Phone: 323-221-5375
  • Fax:
Mailing address:
  • Phone: 818-470-6086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 45520
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: