Healthcare Provider Details

I. General information

NPI: 1750909677
Provider Name (Legal Business Name): MEGAN MARISSA MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2020
Last Update Date: 08/22/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4139 EL CAMINO WAY
PALO ALTO CA
94306-4010
US

IV. Provider business mailing address

1922 THE ALAMEDA STE 316
SAN JOSE CA
95126-1461
US

V. Phone/Fax

Practice location:
  • Phone: 650-617-8340
  • Fax: 408-642-6052
Mailing address:
  • Phone: 408-261-7777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: