Healthcare Provider Details

I. General information

NPI: 1184808693
Provider Name (Legal Business Name): RICARDO MEJIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2007
Last Update Date: 09/29/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 BERKELEY AVE
ROSEVILLE CA
95678-2205
US

IV. Provider business mailing address

201 BERKELEY AVE
ROSEVILLE CA
95678-2205
US

V. Phone/Fax

Practice location:
  • Phone: 916-780-3285
  • Fax:
Mailing address:
  • Phone: 916-780-3285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: