Healthcare Provider Details

I. General information

NPI: 1164712824
Provider Name (Legal Business Name): CARLINA ELIZABETH MEJIA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2011
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S FLORIDA AVE SUITE #210
LAKELAND FL
33801-5276
US

IV. Provider business mailing address

1324 LAKELAND HILLS BLVD ATTN MED STAFF OFFICE
LAKELAND FL
33805-4543
US

V. Phone/Fax

Practice location:
  • Phone: 863-687-1222
  • Fax: 863-603-6546
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME116633
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: