Healthcare Provider Details

I. General information

NPI: 1174792287
Provider Name (Legal Business Name): MANUEL FELIX MEJIA JR. NURSE PRACTITIONER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 09/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W THOMAS RD
PHOENIX AZ
85013-4409
US

IV. Provider business mailing address

7559 W SAN JUAN AVE
GLENDALE AZ
85303-5121
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-4765
  • Fax:
Mailing address:
  • Phone: 602-406-4765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP4337
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP2727
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: