Provider Demographics
NPI:1528305158
Name:MEJIA, BERNADETTE JOYCE (MS, RD)
Entity type:Individual
Prefix:MRS
First Name:BERNADETTE
Middle Name:JOYCE
Last Name:MEJIA
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 72086
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90002-0086
Mailing Address - Country:US
Mailing Address - Phone:818-749-5547
Mailing Address - Fax:
Practice Address - Street 1:5306 BUCHANAN ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042-2444
Practice Address - Country:US
Practice Address - Phone:818-749-5547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1081537133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered