Healthcare Provider Details

I. General information

NPI: 1548664857
Provider Name (Legal Business Name): EVELYN MEJIA SURGICAL TECH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2014
Last Update Date: 10/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 W FAIRGROVE AVE
WEST COVINA CA
91790-4611
US

IV. Provider business mailing address

1229 W FAIRGROVE AVE
WEST COVINA CA
91790-4611
US

V. Phone/Fax

Practice location:
  • Phone: 626-549-5347
  • Fax:
Mailing address:
  • Phone: 626-549-5347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: