Healthcare Provider Details

I. General information

NPI: 1578290102
Provider Name (Legal Business Name): GUADALUPE MEJIA-SARABIA ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14642 NEWPORT AVE STE 200
TUSTIN CA
92780-6058
US

IV. Provider business mailing address

14642 NEWPORT AVE STE 300
TUSTIN CA
92780-6059
US

V. Phone/Fax

Practice location:
  • Phone: 714-247-0300
  • Fax: 714-259-1598
Mailing address:
  • Phone: 714-247-0300
  • Fax: 714-259-1369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: