Healthcare Provider Details

I. General information

NPI: 1154908887
Provider Name (Legal Business Name): LEONARDO IVAN MEJIA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2021
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9348 E RITA RD STE 140
TUCSON AZ
85747-6301
US

IV. Provider business mailing address

5301 E GRANT RD
TUCSON AZ
85712-2805
US

V. Phone/Fax

Practice location:
  • Phone: 520-324-1036
  • Fax: 520-324-1035
Mailing address:
  • Phone: 520-324-2308
  • Fax: 520-324-2051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number011127
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: