Healthcare Provider Details

I. General information

NPI: 1811556368
Provider Name (Legal Business Name): DOMINGO GUTIERREZ MEJIA BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2019
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18860 NORDHOFF ST STE 100
NORTHRIDGE CA
91324-3879
US

IV. Provider business mailing address

18860 NORDHOFF ST STE 100
NORTHRIDGE CA
91324-3879
US

V. Phone/Fax

Practice location:
  • Phone: 818-855-1157
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-89978
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: