Healthcare Provider Details

I. General information

NPI: 1356794416
Provider Name (Legal Business Name): JULIO ADRIAN MEJIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2016
Last Update Date: 07/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3427 4TH AVE
SAN DIEGO CA
92103-4910
US

IV. Provider business mailing address

3427 4TH AVE
SAN DIEGO CA
92103-4910
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 Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: