Healthcare Provider Details

I. General information

NPI: 1275030660
Provider Name (Legal Business Name): MONIQUE MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 04/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

979 GALAPAGO ST
DENVER CO
80204-3940
US

IV. Provider business mailing address

12913 E LOUISIANA AVE
AURORA CO
80012-4416
US

V. Phone/Fax

Practice location:
  • Phone: 303-504-6892
  • Fax:
Mailing address:
  • Phone: 720-276-0126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: