Healthcare Provider Details

I. General information

NPI: 1760549018
Provider Name (Legal Business Name): FIDEL MEJIA RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 09/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 E BELLEVIEW AVE STE 301
GREENWOOD VILLAGE CO
80111-1628
US

IV. Provider business mailing address

6162 S. WILLOW DRIVE SUITE 100
GREENWOOD VILLAGE CO
80111-5114
US

V. Phone/Fax

Practice location:
  • Phone: 303-220-9200
  • Fax:
Mailing address:
  • Phone: 303-220-9200
  • Fax: 303-220-9208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number164428
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: