Healthcare Provider Details

I. General information

NPI: 1922571371
Provider Name (Legal Business Name): MACARIA MEJORADO-MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2019
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 W KATELLA AVE STE 150
ORANGE CA
92867-3432
US

IV. Provider business mailing address

14029 BECKNER ST
LA PUENTE CA
91746-2602
US

V. Phone/Fax

Practice location:
  • Phone: 714-399-3480
  • Fax:
Mailing address:
  • Phone: 626-201-7467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number92721
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: