Healthcare Provider Details

I. General information

NPI: 1831731264
Provider Name (Legal Business Name): MR. MICHAEL MEJIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2019
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 TRIPOLI ST APT 7
RIVERSIDE CA
92507-3909
US

IV. Provider business mailing address

1170 TRIPOLI ST APT 7
RIVERSIDE CA
92507-3909
US

V. Phone/Fax

Practice location:
  • Phone: 951-842-8490
  • Fax:
Mailing address:
  • Phone: 951-842-8490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: