Healthcare Provider Details

I. General information

NPI: 1912701491
Provider Name (Legal Business Name): JOSHUA MEJIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 04/03/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 SE 8TH AVE APT 2850
FORT LAUDERDALE FL
33301-4054
US

IV. Provider business mailing address

6054 FOREST HILL BLVD APT 209
WEST PALM BEACH FL
33415-6210
US

V. Phone/Fax

Practice location:
  • Phone: 800-248-1021
  • Fax:
Mailing address:
  • Phone: 561-541-6352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-416595
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: