Provider Demographics
NPI:1447924667
Name:MEJIA, CHARITY JOY DAZO (RBT)
Entity type:Individual
Prefix:
First Name:CHARITY JOY
Middle Name:DAZO
Last Name:MEJIA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:CHARITY JOY
Other - Middle Name:FLORES
Other - Last Name:DAZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:864 S CLEMENTINE ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-4601
Mailing Address - Country:US
Mailing Address - Phone:714-398-0240
Mailing Address - Fax:
Practice Address - Street 1:4050 KATELLA AVE
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3434
Practice Address - Country:US
Practice Address - Phone:714-333-5670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-21-173519106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician