Provider Demographics
NPI:1093501504
Name:MOREJON MEJIA, GLORIA MELISSA (RDHAP)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:MELISSA
Last Name:MOREJON MEJIA
Suffix:
Gender:
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10559 EDISON WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-5124
Mailing Address - Country:US
Mailing Address - Phone:818-624-4334
Mailing Address - Fax:
Practice Address - Street 1:10559 EDISON WAY
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-5124
Practice Address - Country:US
Practice Address - Phone:818-624-4334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-19
Last Update Date:2025-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1089124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist