Healthcare Provider Details

I. General information

NPI: 1376951160
Provider Name (Legal Business Name): VIOLA MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2014
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4126 TELEGRAPH AVE
OAKLAND CA
94609
US

IV. Provider business mailing address

4126 TELEGRAPH AVE
OAKLAND CA
94609
US

V. Phone/Fax

Practice location:
  • Phone: 415-928-7800
  • Fax:
Mailing address:
  • Phone: 510-342-9132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY33293
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: