Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | QASP-S9313 | CA |
NPI | 1114446192 |
---|---|
Provider Name | Marcela Mejia |
First Address | Vista, CA 92081-8772 |
Second Address | San Diego, CA 92121-3109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2017 |
Last Update Date | 16/11/2018 |