Healthcare Provider Details

I. General information

NPI: 1518322718
Provider Name (Legal Business Name): JOSUE MEJIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2015
Last Update Date: 12/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2712 MISSION ST
SAN FRANCISCO CA
94110-3104
US

IV. Provider business mailing address

2712 MISSION ST
SAN FRANCISCO CA
94110-3104
US

V. Phone/Fax

Practice location:
  • Phone: 415-401-2733
  • Fax:
Mailing address:
  • Phone: 415-401-2733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number00057078
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: