Healthcare Provider Details

I. General information

NPI: 1710120076
Provider Name (Legal Business Name): LUZ ADRIANA MEJIA-PLATA M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LUZ ADRIANA MEJIA-PLATA MS CCC-SLP

II. Dates (important events)

Enumeration Date: 04/15/2009
Last Update Date: 04/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 ASH DR
HOLLYWOOD FL
33026-1102
US

IV. Provider business mailing address

9710 DARLINGTON PL
COOPER CITY FL
33328-5800
US

V. Phone/Fax

Practice location:
  • Phone: 561-767-4421
  • Fax:
Mailing address:
  • Phone: 917-804-5551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA12074
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: