Healthcare Provider Details

I. General information

NPI: 1568280568
Provider Name (Legal Business Name): FANNY CARITO MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 09/30/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18110 CASHELL RD
ROCKVILLE MD
20853-1031
US

IV. Provider business mailing address

2119 CHAPMAN RD
HYATTSVILLE MD
20783-4904
US

V. Phone/Fax

Practice location:
  • Phone: 301-706-8611
  • Fax:
Mailing address:
  • Phone: 240-550-7245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: