Healthcare Provider Details

I. General information

NPI: 1487381679
Provider Name (Legal Business Name): ELIJAH JAMES MEJIA CAJIGAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2022
Last Update Date: 08/07/2022
Certification Date: 08/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 GARLAND ST
EVERETT MA
02149-5066
US

IV. Provider business mailing address

508 ELLIOTT ST APT 2L
BEVERLY MA
01915-2349
US

V. Phone/Fax

Practice location:
  • Phone: 627-061-7389
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: