Healthcare Provider Details

I. General information

NPI: 1174871263
Provider Name (Legal Business Name): SILVIA MEJIA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2012
Last Update Date: 08/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 NEARY CT
ROSAMOND CA
93560-5932
US

IV. Provider business mailing address

1600 W AVENUE J
LANCASTER CA
93534-2814
US

V. Phone/Fax

Practice location:
  • Phone: 661-256-5914
  • Fax:
Mailing address:
  • Phone: 661-949-5025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS25427
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: