Healthcare Provider Details

I. General information

NPI: 1164047114
Provider Name (Legal Business Name): ANA MARIA MEJIA CARDENAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 06/29/2025
Certification Date: 06/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1595 N LAKE AVE
PASADENA CA
91104-2307
US

IV. Provider business mailing address

1595 N LAKE AVE
PASADENA CA
91104-2307
US

V. Phone/Fax

Practice location:
  • Phone: 888-499-9303
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA183101
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: