Healthcare Provider Details

I. General information

NPI: 1669854303
Provider Name (Legal Business Name): SARA MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2015
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20501 VENTURA BLVD
WOODLAND HILLS CA
91364
US

IV. Provider business mailing address

6151 RESEDA BLVD UNIT 1
TARZANA CA
91335-7352
US

V. Phone/Fax

Practice location:
  • Phone: 818-657-0411
  • Fax:
Mailing address:
  • Phone: 818-915-1199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: