Healthcare Provider Details

I. General information

NPI: 1093619272
Provider Name (Legal Business Name): ANDREA SAMANTHA MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 E HOSPITALITY LN STE 400
SAN BERNARDINO CA
92408-3545
US

IV. Provider business mailing address

9414 VAN NUYS BLVD APT 214
PANORAMA CITY CA
91402-1342
US

V. Phone/Fax

Practice location:
  • Phone: 909-891-1599
  • Fax: 909-891-1599
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: