Healthcare Provider Details

I. General information

NPI: 1851193700
Provider Name (Legal Business Name): MARYCRUZ MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8287 WHITE OAK AVE
RANCHO CUCAMONGA CA
91730-7671
US

IV. Provider business mailing address

8288 CHANTRY AVE
FONTANA CA
92335-3420
US

V. Phone/Fax

Practice location:
  • Phone: 909-466-4001
  • Fax:
Mailing address:
  • Phone: 909-201-4975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: