Provider Demographics
NPI:1457742330
Name:MEJIA, SASHA
Entity Type:Individual
Prefix:
First Name:SASHA
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 1:23430 HAWTHORNE BLVD
Mailing Address - Street 2:STE 325
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4718
Mailing Address - Country:US
Mailing Address - Phone:310-705-8323
Mailing Address - Fax:310-683-6321
Practice Address - Street 1:23430 HAWTHORNE BLVD
Practice Address - Street 2:BLDG 3 SUITE 325
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4720
Practice Address - Country:US
Practice Address - Phone:310-705-8323
Practice Address - Fax:310-683-6321
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA730822163W00000X
CANP95002102363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse