Healthcare Provider Details

I. General information

NPI: 1629225727
Provider Name (Legal Business Name): MARIA MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 4TH AVE STE 301
SAN DIEGO CA
92101-2124
US

IV. Provider business mailing address

2250 4TH AVE STE 301
SAN DIEGO CA
92101-2124
US

V. Phone/Fax

Practice location:
  • Phone: 619-525-9903
  • Fax: 619-525-9908
Mailing address:
  • Phone: 619-525-9903
  • Fax: 619-525-9908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: