Healthcare Provider Details

I. General information

NPI: 1386563229
Provider Name (Legal Business Name): MC KAYLA DENISE MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25917 W LINCOLN AVE
TRANQUILLITY CA
93668-9757
US

IV. Provider business mailing address

25917 W LINCOLN AVE
TRANQUILLITY CA
93668-9757
US

V. Phone/Fax

Practice location:
  • Phone: 559-270-4838
  • Fax:
Mailing address:
  • Phone: 559-270-4838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberY8343555
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: