Healthcare Provider Details

I. General information

NPI: 1104345255
Provider Name (Legal Business Name): CLAUDIA MARITZA MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2017
Last Update Date: 09/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 W HORIZON RIDGE PKWY STE 210
HENDERSON NV
89012-6020
US

IV. Provider business mailing address

2601 S GRAND CAN DR APT 2029
LAS VEGAS NV
89117-3672
US

V. Phone/Fax

Practice location:
  • Phone: 702-907-6717
  • Fax:
Mailing address:
  • Phone: 210-838-8097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY0819
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: