Provider Demographics
NPI:1750601993
Name:MEJIA, RIA HERMOSILLA (MED,OTR/L)
Entity type:Individual
Prefix:MS
First Name:RIA
Middle Name:HERMOSILLA
Last Name:MEJIA
Suffix:
Gender:F
Credentials:MED,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6588 EUCALYPTUS AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-0101
Mailing Address - Country:US
Mailing Address - Phone:323-241-2019
Mailing Address - Fax:
Practice Address - Street 1:621 W BONITA AVE
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711
Practice Address - Country:US
Practice Address - Phone:323-241-2019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13878225X00000X
TX113232225X00000X
CA14634225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist