MEDICARE: DR. RITA MARIA MEJIA-BRAECKEVELT DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician	OS12604	FL
2	207Q00000X	Family Medicine Physician	DO2522	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	010056150	OTHER	MI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	080B610190	OTHER	MI	BLUE CROSS
4	5772254	OTHER	MI	AETNA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457343576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RITA MARIA MEJIA-BRAECKEVELT DO

Provider Business Mailing Address
First Line	:	482 BULLDOG DR
Second Line	:
City	:	MESQUITE
State	:	NV
Zip	:	89027-3103
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 N SANDHILL BLVD
Second Line	:
City	:	MESQUITE
State	:	NV
Zip	:	89027-4789
Country	:	US
Telephone Number	:	702-849-0558
Fax Number	:	702-346-2147

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	01/20/2025

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Directions to “ DR. RITA MARIA MEJIA-BRAECKEVELT DO” Practice Location

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