Healthcare Provider Details

I. General information

NPI: 1922848621
Provider Name (Legal Business Name): NELSON MEJIA GONZALEZ
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 LAUREL CANYON BLVD STE 500
NORTH HOLLYWOOD CA
91606-1562
US

IV. Provider business mailing address

14430 VALERIO ST APT F3
VAN NUYS CA
91405-2376
US

V. Phone/Fax

Practice location:
  • Phone: 818-901-4879
  • Fax: 818-997-1370
Mailing address:
  • Phone: 818-579-1464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: