Healthcare Provider Details

I. General information

NPI: 1407211881
Provider Name (Legal Business Name): ERNEST RITUALO MEJIA P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2015
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 W 35TH ST STE 101
NATIONAL CITY CA
91950-7926
US

IV. Provider business mailing address

22 W 35TH ST STE 101
NATIONAL CITY CA
91950-7926
US

V. Phone/Fax

Practice location:
  • Phone: 619-427-3361
  • Fax:
Mailing address:
  • Phone: 619-427-3361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number53105
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: