Healthcare Provider Details

I. General information

NPI: 1508204801
Provider Name (Legal Business Name): DIANA CATALINA MEJIA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20601 OLD CUTLER RD
MIAMI FL
33189-4452
US

IV. Provider business mailing address

15180 SW 156 AVE
MIAMI FL
33196
US

V. Phone/Fax

Practice location:
  • Phone: 305-259-6392
  • Fax:
Mailing address:
  • Phone: 786-387-0633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN5203915
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9449280
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: