Provider Demographics
NPI:1871602839
Name:MEJIA, CYNTHIA YANINA (PA-C)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:YANINA
Last Name:MEJIA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14968 OAKBURY DR
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-4531
Mailing Address - Country:US
Mailing Address - Phone:818-523-2324
Mailing Address - Fax:
Practice Address - Street 1:1950 SUNNY CREST DR STE 2600
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3644
Practice Address - Country:US
Practice Address - Phone:714-446-5260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17479207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA17479Medicaid