Provider Demographics
NPI:1861092314
Name:MEJIA, VIVIAN ANAIZ
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:ANAIZ
Last Name:MEJIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10919 SEPULVEDA BLVD UNIT 7803
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91346-5036
Mailing Address - Country:US
Mailing Address - Phone:818-358-9648
Mailing Address - Fax:
Practice Address - Street 1:11631 VICTORY BLVD STE 203
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3572
Practice Address - Country:US
Practice Address - Phone:818-908-3855
Practice Address - Fax:818-753-5265
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist