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General NPI Number Information
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NPI Number | 1659088219
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Entity Type | Individual
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Provider Name | GEORGINA MEJIA
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Gender | Female
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Dates
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Enumeration Date | 11/03/2022
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Last Update Date | 11/03/2022
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Provider Practice Location Address
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Address Line | 17000 VENTURA BLVD STE 100B
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City | ENCINO
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State | CA
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Zip | 91316-4109
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Country | US
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Telephone | 818-302-5752
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Fax |
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Provider Business Mailing Address
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Address Line | 12700 VAN NUYS BLVD APT 300
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City | PACOIMA
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State | CA
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Zip | 91331-1625
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Country | US
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Telephone | 818-671-8869
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Fax |
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 82610
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License Number State | CA
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