Provider Demographics
NPI:1760711642
Name:MEJIA, RYAN M (CDS)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:M
Last Name:MEJIA
Suffix:
Gender:M
Credentials:CDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3063 ESPANA LN
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-4921
Mailing Address - Country:US
Mailing Address - Phone:818-687-1442
Mailing Address - Fax:
Practice Address - Street 1:3063 ESPANA LN
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-4921
Practice Address - Country:US
Practice Address - Phone:818-687-1442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor