Healthcare Provider Details

I. General information

NPI: 1962083386
Provider Name (Legal Business Name): LLOYD MEJIA DELACRUZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 MORSE AVE
SACRAMENTO CA
95825-2115
US

IV. Provider business mailing address

7012 RAWLEY WAY
ELK GROVE CA
95757-4039
US

V. Phone/Fax

Practice location:
  • Phone: 916-973-7737
  • Fax:
Mailing address:
  • Phone: 916-793-4499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number642896
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: