Healthcare Provider Details

I. General information

NPI: 1457343576
Provider Name (Legal Business Name): RITA MARIA MEJIA-BRAECKEVELT DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RITA MARIA SECK DO

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N SANDHILL BLVD
MESQUITE NV
89027-4789
US

IV. Provider business mailing address

482 BULLDOG DR
MESQUITE NV
89027-3103
US

V. Phone/Fax

Practice location:
  • Phone: 702-849-0558
  • Fax: 702-346-2147
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberOS12604
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO2522
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: