Provider Demographics
NPI:1710017348
Name:MEJICO, ANTONIO JR
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:
Last Name:MEJICO
Suffix:JR
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 1:1937 W CHAPMAN AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2607
Mailing Address - Country:US
Mailing Address - Phone:714-385-5260
Mailing Address - Fax:
Practice Address - Street 1:1937 W CHAPMAN AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2607
Practice Address - Country:US
Practice Address - Phone:714-385-5260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health