Healthcare Provider Details

I. General information

NPI: 1528305158
Provider Name (Legal Business Name): BERNADETTE JOYCE MEJIA M.S., R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2013
Last Update Date: 01/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5306 BUCHANAN ST
LOS ANGELES CA
90042-2444
US

IV. Provider business mailing address

PO BOX 72086
LOS ANGELES CA
90002-0086
US

V. Phone/Fax

Practice location:
  • Phone: 818-749-5547
  • Fax:
Mailing address:
  • Phone: 818-749-5547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1081537
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: