Healthcare Provider Details

I. General information

NPI: 1457870719
Provider Name (Legal Business Name): ODILLE PATRICIA MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2017
Last Update Date: 09/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 ALTON RD FL 33140
MIAMI BEACH FL
33140-2948
US

IV. Provider business mailing address

1501 71ST ST
MIAMI BEACH FL
33141-4709
US

V. Phone/Fax

Practice location:
  • Phone: 305-674-2277
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number25804
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: