Provider Demographics
NPI:1629409990
Name:MEJIA, ROBERTO LUIS
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:LUIS
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 1:5529 LAS BRISAS TER
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-5749
Mailing Address - Country:US
Mailing Address - Phone:661-361-2783
Mailing Address - Fax:
Practice Address - Street 1:1007 W AVENUE M14
Practice Address - Street 2:STE. C
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-1443
Practice Address - Country:US
Practice Address - Phone:661-361-2783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst