Healthcare Provider Details

I. General information

NPI: 1215258447
Provider Name (Legal Business Name): JOSE MANUEL MEJIA ONETO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 11/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 SUNRISE AVE
ROSEVILLE CA
95661-4502
US

IV. Provider business mailing address

PO BOX 619115
ROSEVILLE CA
95661-9115
US

V. Phone/Fax

Practice location:
  • Phone: 916-791-1300
  • Fax: 916-734-7904
Mailing address:
  • Phone: 916-791-1300
  • Fax: 916-734-7904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA118724
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA118724
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: