Healthcare Provider Details

I. General information

NPI: 1043233463
Provider Name (Legal Business Name): CARMEN RAFAELA MEJIA-CARVAJAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 03/30/2024
Certification Date: 03/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5640 W ATLANTIC BLVD
MARGATE FL
33063-4523
US

IV. Provider business mailing address

1228 GOLDEN CANE DR
WESTON FL
33327-2423
US

V. Phone/Fax

Practice location:
  • Phone: 954-657-8060
  • Fax: 866-525-2237
Mailing address:
  • Phone: 954-716-9728
  • Fax: 954-213-6507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number13717
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number036-112870
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME116888
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: