Healthcare Provider Details

I. General information

NPI: 1699023291
Provider Name (Legal Business Name): NIRLA P MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 MCHENRY VILLAGE WAY SUITE 11
MODESTO CA
95350-4308
US

IV. Provider business mailing address

1700 MCHENRY VILLAGE WAY SUITE 11
MODESTO CA
95350-4308
US

V. Phone/Fax

Practice location:
  • Phone: 209-526-1440
  • Fax: 209-550-4903
Mailing address:
  • Phone: 209-526-1440
  • Fax: 209-550-4903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: