Healthcare Provider Details

I. General information

NPI: 1700029618
Provider Name (Legal Business Name): MARIUXI MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2009
Last Update Date: 12/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 FOREST HILL BLVD
WEST PALM BEACH FL
33406-5931
US

IV. Provider business mailing address

2640 FOREST HILL BLVD
WEST PALM BEACH FL
33406-5931
US

V. Phone/Fax

Practice location:
  • Phone: 772-971-1363
  • Fax:
Mailing address:
  • Phone: 772-971-1363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW 10597
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: