=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760373971
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICARDO MEJIA SALAS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2025
-----------------------------------------------------
Last Update Date | 07/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4301 S TACOMA WAY # WA98409
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98409-4522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-671-9909
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3333 N VISSCHER ST
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98407-1539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-324-2039
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number | CBT.CB.61655059
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------