Healthcare Provider Details

I. General information

NPI: 1174317473
Provider Name (Legal Business Name): EMMANUEL CARLOS MEJIA REGISTERED NURSE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 04/09/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 FRANKLIN ST STE 200
OAKLAND CA
94612-3208
US

IV. Provider business mailing address

1404 FRANKLIN ST STE 200
OAKLAND CA
94612-3208
US

V. Phone/Fax

Practice location:
  • Phone: 510-529-5352
  • Fax:
Mailing address:
  • Phone: 510-529-5352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number95174417
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: