Provider Demographics
NPI:1619644143
Name:MEJIA, GIORDANO
Entity Type:Individual
Prefix:
First Name:GIORDANO
Middle Name:
Last Name:MEJIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4113 SEYMOUR ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-2904
Mailing Address - Country:US
Mailing Address - Phone:951-470-4029
Mailing Address - Fax:
Practice Address - Street 1:4113 SEYMOUR ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-2904
Practice Address - Country:US
Practice Address - Phone:951-470-4029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician