Provider Demographics
NPI:1922848621
Name:MEJIA GONZALEZ, NELSON
Entity type:Individual
Prefix:
First Name:NELSON
Middle Name:
Last Name:MEJIA GONZALEZ
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14430 VALERIO ST APT F3
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-2376
Mailing Address - Country:US
Mailing Address - Phone:818-579-1464
Mailing Address - Fax:
Practice Address - Street 1:6400 LAUREL CANYON BLVD STE 500
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-1562
Practice Address - Country:US
Practice Address - Phone:818-901-4879
Practice Address - Fax:818-997-1370
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical