Healthcare Provider Details

I. General information

NPI: 1922627751
Provider Name (Legal Business Name): KARLA MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2020
Last Update Date: 04/12/2020
Certification Date: 04/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CULVER AVE
JERSEY CITY NJ
07305-1529
US

IV. Provider business mailing address

1078 CEDAR AVE
UNION NJ
07083-3611
US

V. Phone/Fax

Practice location:
  • Phone: 201-200-3063
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number25MT00230900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: