Provider Demographics
NPI:1700325891
Name:MEJIA, MA CHRISTINA
Entity type:Individual
Prefix:
First Name:MA CHRISTINA
Middle Name:
Last Name:MEJIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIA CHRISTINA
Other - Middle Name:
Other - Last Name:MEJIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15029 VISTA VW
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-7214
Mailing Address - Country:US
Mailing Address - Phone:719-502-5928
Mailing Address - Fax:
Practice Address - Street 1:15029 VISTA VW
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-7214
Practice Address - Country:US
Practice Address - Phone:719-502-5928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA750721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical