Provider Demographics
NPI:1629552153
Name:MEJIA, CHRISTINA (MS CCC -SLP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:MEJIA
Suffix:
Gender:F
Credentials:MS CCC -SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 SHADELANDS DR BLDG 10
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2538
Mailing Address - Country:US
Mailing Address - Phone:209-483-7472
Mailing Address - Fax:
Practice Address - Street 1:1633 OLD BAYSHORE HWY STE 155
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-1515
Practice Address - Country:US
Practice Address - Phone:510-406-4067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18483235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist