Provider Demographics
NPI:1790232320
Name:MEJIA, SYLVIA
Entity Type:Individual
Prefix:
First Name:SYLVIA
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 1:1 W CALIFORNIA BLVD STE 221
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3032
Mailing Address - Country:US
Mailing Address - Phone:626-214-8027
Mailing Address - Fax:
Practice Address - Street 1:1 W CALIFORNIA BLVD STE 221
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3032
Practice Address - Country:US
Practice Address - Phone:626-214-8027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF94973106H00000X
CALMFT111909106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist