Provider Demographics
NPI:1619342078
Name:MISSION MENTAL HEALTH CLINIC
Entity Type:Organization
Organization Name:MISSION MENTAL HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH WORKER II
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSUE
Authorized Official - Middle Name:N
Authorized Official - Last Name:MEJIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-401-2733
Mailing Address - Street 1:2712 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-3104
Mailing Address - Country:US
Mailing Address - Phone:415-401-2733
Mailing Address - Fax:
Practice Address - Street 1:2712 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3104
Practice Address - Country:US
Practice Address - Phone:415-401-2733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00057078291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory