Healthcare Provider Details

I. General information

NPI: 1699270801
Provider Name (Legal Business Name): LUIS MANUEL MEJIA GARCIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4730 N HABANA AVE STE 101
TAMPA FL
33614-7165
US

IV. Provider business mailing address

4730 N HABANA AVE STE 101
TAMPA FL
33614-7165
US

V. Phone/Fax

Practice location:
  • Phone: 813-955-4289
  • Fax: 813-537-1034
Mailing address:
  • Phone: 813-955-4289
  • Fax: 813-537-1034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME149007
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: