Healthcare Provider Details

I. General information

NPI: 1770964959
Provider Name (Legal Business Name): IVONNE MILAGROS MEJIA PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2015
Last Update Date: 04/30/2023
Certification Date: 04/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 P ST STE 106
SACRAMENTO CA
95811-5225
US

IV. Provider business mailing address

2011 P ST STE 106
SACRAMENTO CA
95811-5225
US

V. Phone/Fax

Practice location:
  • Phone: 916-287-1625
  • Fax:
Mailing address:
  • Phone: 916-287-1625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY29656
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: