Healthcare Provider Details

I. General information

NPI: 1942255294
Provider Name (Legal Business Name): PAULETTE KIM MEJIA DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 09/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 W 20TH AVE SUITE 105-106
HIALEAH FL
33016-1821
US

IV. Provider business mailing address

7600 W 20TH AVE SUITE 105-106
HIALEAH FL
33016-1821
US

V. Phone/Fax

Practice location:
  • Phone: 786-879-7489
  • Fax: 305-557-1609
Mailing address:
  • Phone: 786-879-7489
  • Fax: 305-557-1609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH7850
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: