Healthcare Provider Details

I. General information

NPI: 1659041523
Provider Name (Legal Business Name): JOSELINE CATHY MEJIA-CRUZ QMHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 09/14/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 N TENAYA WAY
LAS VEGAS NV
89128-1409
US

IV. Provider business mailing address

2921 N TENAYA WAY
LAS VEGAS NV
89128-1409
US

V. Phone/Fax

Practice location:
  • Phone: 702-942-1774
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: