Healthcare Provider Details

I. General information

NPI: 1760914394
Provider Name (Legal Business Name): LADY KATHERINE MEJIA PEREZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2017
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 LEAD AVE SE
ALBUQUERQUE NM
87106-5215
US

IV. Provider business mailing address

PO BOX 26666
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-224-7000
  • Fax: 505-224-7292
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD2024-1020
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: