Healthcare Provider Details

I. General information

NPI: 1851251318
Provider Name (Legal Business Name): JESENIA MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 11/17/2025
Certification Date: 11/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 PILOT RD STE L
LAS VEGAS NV
89119-4437
US

IV. Provider business mailing address

9288 VALLEY RANCH AVE
LAS VEGAS NV
89178-5526
US

V. Phone/Fax

Practice location:
  • Phone: 702-550-2791
  • Fax:
Mailing address:
  • Phone: 702-550-2791
  • Fax: 702-745-0488

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: