Healthcare Provider Details

I. General information

NPI: 1932864824
Provider Name (Legal Business Name): AURORA MEJIA F10210880 FNP NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2021
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 MCHENRY AVE STE A
MODESTO CA
95350-5379
US

IV. Provider business mailing address

9805 SW 161ST PL
MIAMI FL
33196-6603
US

V. Phone/Fax

Practice location:
  • Phone: 786-556-0561
  • Fax:
Mailing address:
  • Phone: 786-556-0561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF10210880
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP95023718
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: