Healthcare Provider Details

I. General information

NPI: 1346621935
Provider Name (Legal Business Name): LISA A MEJIA RDN,LDN,CDCDES,IFNCP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2015
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 FRUITLAND DR
DELTONA FL
32725-4594
US

IV. Provider business mailing address

1720 FRUITLAND DR
DELTONA FL
32725-4594
US

V. Phone/Fax

Practice location:
  • Phone: 786-923-6039
  • Fax:
Mailing address:
  • Phone: 786-923-6039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL007271
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number5461
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number4698-NU-NU
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND6219
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: