Provider Demographics
NPI:1770016255
Name:MEJIA, MELISSA (MS,BCBA)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:MEJIA
Suffix:
Gender:F
Credentials:MS,BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15649 NORTHWIND AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-4190
Mailing Address - Country:US
Mailing Address - Phone:213-210-8567
Mailing Address - Fax:
Practice Address - Street 1:15649 NORTHWIND AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-4190
Practice Address - Country:US
Practice Address - Phone:213-210-8567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-17-24984103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst