Healthcare Provider Details

I. General information

NPI: 1326301094
Provider Name (Legal Business Name): LOURDES PATRICIA MEJIA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4214 BEVERLY BLVD STE 212
LOS ANGELES CA
90004-4479
US

IV. Provider business mailing address

4214 W BEVERLY BLVD STE 212
LOS ANGELES CA
90004-4429
US

V. Phone/Fax

Practice location:
  • Phone: 213-385-9912
  • Fax: 213-385-9915
Mailing address:
  • Phone: 213-385-9912
  • Fax: 213-385-9915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number21316
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60616598
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: