Healthcare Provider Details

I. General information

NPI: 1316437221
Provider Name (Legal Business Name): DORA MARIA MEJIA IN HOME SUPPORT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 04/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 W BUSCH BLVD
TAMPA FL
33612-7704
US

IV. Provider business mailing address

1020 W BUSCH BLVD
TAMPA FL
33612-7704
US

V. Phone/Fax

Practice location:
  • Phone: 813-531-0360
  • Fax: 813-252-9688
Mailing address:
  • Phone: 813-531-0360
  • Fax: 813-252-9688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: