Healthcare Provider Details

I. General information

NPI: 1538605944
Provider Name (Legal Business Name): ADOLF0 MEJIA M.ED.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3602 INLAND EMPIRE BLVD STE B208
ONTARIO CA
91764-4912
US

IV. Provider business mailing address

4175 ADAMS ST
RIVERSIDE CA
92504-3003
US

V. Phone/Fax

Practice location:
  • Phone: 909-491-9363
  • Fax:
Mailing address:
  • Phone: 626-367-7002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberE1349108
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-35343
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: