Healthcare Provider Details

I. General information

NPI: 1821689944
Provider Name (Legal Business Name): DIANA MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 LAMOILLE HWY STE 103
ELKO NV
89801-4397
US

IV. Provider business mailing address

812 LONNIE LN
WINNEMUCCA NV
89445-7751
US

V. Phone/Fax

Practice location:
  • Phone: 775-777-1292
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: