Provider Demographics
NPI:1285398263
Name:MEJIA, MARIA GESEL
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:GESEL
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 1:81351 FRED WARING DR APT 118
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-1903
Mailing Address - Country:US
Mailing Address - Phone:760-916-2868
Mailing Address - Fax:
Practice Address - Street 1:81351 FRED WARING DR APT 118
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-1903
Practice Address - Country:US
Practice Address - Phone:760-916-2868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty