Provider Demographics
NPI:1073306932
Name:MEJIA, RITA FOGATA (RDN)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:FOGATA
Last Name:MEJIA
Suffix:
Gender:X
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3017 EUCALYPTUS AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1348
Mailing Address - Country:US
Mailing Address - Phone:562-328-9554
Mailing Address - Fax:
Practice Address - Street 1:3017 EUCALYPTUS AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1348
Practice Address - Country:US
Practice Address - Phone:562-328-9554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X, 133V00000X
CA895475133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education