Healthcare Provider Details

I. General information

NPI: 1881458362
Provider Name (Legal Business Name): BLANCA NOEMI MEJIA MILLS ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 W SONORA ST
STOCKTON CA
95203-3329
US

IV. Provider business mailing address

455 N TUXEDO AVE
STOCKTON CA
95204-5237
US

V. Phone/Fax

Practice location:
  • Phone: 209-337-3298
  • Fax:
Mailing address:
  • Phone: 209-390-6088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number132665
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: