Provider Demographics
NPI:1780472035
Name:MEJIA, EMMANUEL (PPS)
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:
Last Name:MEJIA
Suffix:
Gender:M
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 N M ST
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-3906
Mailing Address - Country:US
Mailing Address - Phone:805-385-1539
Mailing Address - Fax:
Practice Address - Street 1:1130 N M ST
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-3906
Practice Address - Country:US
Practice Address - Phone:805-385-1539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health