Provider Demographics
NPI:1669854303
Name:MEJIA, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:MEJIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6151 RESEDA BLVD
Mailing Address - Street 2:UNIT 1
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-7352
Mailing Address - Country:US
Mailing Address - Phone:818-915-1199
Mailing Address - Fax:
Practice Address - Street 1:20501 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364
Practice Address - Country:US
Practice Address - Phone:818-657-0411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-18
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional