Healthcare Provider Details

I. General information

NPI: 1457742330
Provider Name (Legal Business Name): SASHA MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2015
Last Update Date: 10/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23430 HAWTHORNE BLVD BLDG 3 SUITE 325
TORRANCE CA
90505-4720
US

IV. Provider business mailing address

23430 HAWTHORNE BLVD STE 325
TORRANCE CA
90505-4718
US

V. Phone/Fax

Practice location:
  • Phone: 310-705-8323
  • Fax: 310-683-6321
Mailing address:
  • Phone: 310-705-8323
  • Fax: 310-683-6321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number730822
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP95002102
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: