Healthcare Provider Details

I. General information

NPI: 1093492027
Provider Name (Legal Business Name): VERONICA YVONNE MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

1690 SOUTHWEST EXPY
SAN JOSE CA
95126-4400
US

IV. Provider business mailing address

1690 SOUTHWEST EXPY
SAN JOSE CA
95126-4400
US

V. Phone/Fax

Practice location:
  • Phone: 510-453-0679
  • Fax:
Mailing address:
  • Phone: 510-453-0679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: