Provider Demographics
NPI:1538605944
Name:MEJIA, ADOLF0 (MED)
Entity type:Individual
Prefix:
First Name:ADOLF0
Middle Name:
Last Name:MEJIA
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4175 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-3003
Mailing Address - Country:US
Mailing Address - Phone:626-367-7002
Mailing Address - Fax:
Practice Address - Street 1:3602 INLAND EMPIRE BLVD STE B208
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-4912
Practice Address - Country:US
Practice Address - Phone:909-491-9363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-09
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1349108106S00000X
CA1-19-35343103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician