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General NPI Number Information
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NPI Number | 1194919886
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Entity Type | Individual
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Provider Name | JACQUELINE JOYCE D'MEZA LMFT
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Gender | Female
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Dates
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Enumeration Date | 09/05/2007
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Last Update Date | 09/05/2007
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Provider Practice Location Address
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Address Line | 4247 W 61ST ST
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City | LOS ANGELES
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State | CA
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Zip | 90043-3608
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Country | US
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Telephone | 323-292-4633
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Fax | 323-292-4633
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Provider Business Mailing Address
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Address Line | 2600 S LA BREA AVE SUIT 11
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City | LOS ANGELES
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State | CA
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Zip | 90016-2807
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Country | US
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Telephone | 626-393-9193
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Fax | 323-292-4633
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC40249
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License Number State | CA
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