Healthcare Provider Details

I. General information

NPI: 1093216293
Provider Name (Legal Business Name): JESUS MEJIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 02/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 S JONES BLVD
LAS VEGAS NV
89107-2623
US

IV. Provider business mailing address

2829 BASSLER ST
NORTH LAS VEGAS NV
89030-5220
US

V. Phone/Fax

Practice location:
  • Phone: 702-953-7910
  • Fax: 702-750-2250
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: