Healthcare Provider Details

I. General information

NPI: 1609361781
Provider Name (Legal Business Name): KANDY SUSANA MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6737 BRIGHT AVE STE 101
WHITTIER CA
90601-4313
US

IV. Provider business mailing address

PO BOX 1322
SOUTH PASADENA CA
91031-1322
US

V. Phone/Fax

Practice location:
  • Phone: 626-470-7139
  • Fax:
Mailing address:
  • Phone: 323-972-0447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number110638
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: