Basic Information
| Provider Information | |||||||||
| NPI: | 1932273968 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEJIA-NOVOA | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | ANGELES | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MEJIA | ||||||||
| OtherFirstName: | MARIA | ||||||||
| OtherMiddleName: | ANGELES | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PHYSICIAN ASSISTANT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7400 MULLER ST | ||||||||
| Address2: | |||||||||
| City: | DOWNEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902412136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628971956 | ||||||||
| FaxNumber: | 5622912246 | ||||||||
| Practice Location | |||||||||
| Address1: | 5425 POMONA BLVD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900221716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237280411 | ||||||||
| FaxNumber: | 3238695362 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2006 | ||||||||
| LastUpdateDate: | 11/15/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 13586 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.