Healthcare Provider Details

I. General information

NPI: 1528457504
Provider Name (Legal Business Name): ELIZABETH MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2015
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21545 CENTRE POINTE PKWY
SANTA CLARITA CA
91350-2947
US

IV. Provider business mailing address

21545 CENTRE POINTE PKWY
SANTA CLARITA CA
91350-2947
US

V. Phone/Fax

Practice location:
  • Phone: 661-313-0352
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: