Provider Demographics
NPI:1508363813
Name:MEJIA-SORTO, JULISSA VANESSA (BCBA)
Entity Type:Individual
Prefix:
First Name:JULISSA
Middle Name:VANESSA
Last Name:MEJIA-SORTO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 HYDE AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-2507
Mailing Address - Country:US
Mailing Address - Phone:213-880-3861
Mailing Address - Fax:
Practice Address - Street 1:835 HYDE AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-2507
Practice Address - Country:US
Practice Address - Phone:213-880-3861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-18-30159103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst