Provider Demographics
NPI:1720707086
Name:MEJIA, ANALISA ROSE
Entity Type:Individual
Prefix:
First Name:ANALISA
Middle Name:ROSE
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 1:18860 NORDHOFF ST STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-3879
Mailing Address - Country:US
Mailing Address - Phone:818-270-1769
Mailing Address - Fax:
Practice Address - Street 1:18860 NORDHOFF ST STE 100
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-3879
Practice Address - Country:US
Practice Address - Phone:818-270-1769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst